Monday, 9 April 2018

Benign MS. Features that lead to continued activity in the long term

Some people tolerate MS quite well for a long time,

This study shows that benign MS, is not inactive MS and many people continue to worsen over time. 

This means that is you are treating early and aggressively, you will be possibly over-treating some people. However, it says you perhaps want a safe induction treatment, when you can treat early and then wait to see if disease returns. Maybe you can nip it in the bud ( Halt something at an early stage)

Fabis-Pedrini MJ, James I, Seewann A, Yau WY, van de Bovenkamp AA, Sanders FRK, Qiu W, Burton J, Mastaglia FL, Carroll WM, Kermode AG. Natural history of benign multiple sclerosis: Clinical correlates in a Western Australian cohort. J Neurol Sci. 2018 May 15;388:12-18.

BACKGROUND:

Benign multiple sclerosis (BMS) is a controversial term that has been used for MS patients with minimal disability decades after disease onset. Herein, we evaluated disease status after 20 years in a Western Australian cohort defined as BMS based on an Expanded Disability Status Scale (EDSS) score ≤ 3.0 at 10 years from onset.

METHODS:

MS patients with an EDSS score ≤ 3.0 at 10 years from onset and minimum of 20 years follow up were included in the study. The 20-year EDSS score was considered the primary outcome. 

RESULTS:

Among 120 patients with a benign course at 10 years, 78 (65%) remained benign at the 20-year follow up, but patients with an EDSS ≥ 2.5 were more likely to go on to develop more severe disability in the next decade. When considering factors associated with an increase in EDSS score ≤ 1 from 10 to 20 years, indicating limited progression, apart from the EDSS score at 10 years, poly-symptomatic presentation (p = 0.004) and cerebellar/brainstem mono-symptomatic presentation (p = 0.016) were independently associated with more rapid progression compared with other mono-symptomatic presentations. 

CONCLUSIONS:

In this geographically isolated MS cohort of predominantly Anglo-Celtic origin clinical progression in the benign MS group was similar to that in other published series from Western countries. These results are in keeping with the view that patients labeled as benign MS are part of a heterogeneous continuum of disease progression and do not possess unique clinical characteristics. 

4 comments:

  1. I had my first symptom in May 1994 - optic neuritis. It was very, very mild and barely perceptible. I went to various doctors and was eventually given a scan in Barts (?) I can’t remember. Anyway, nothing was diagnosed. I had no further symptoms, (although I have tended towards depression for years) until 2010 ish when I had short episodes of tingling and loss of feeling, but again barely perceptible – they were so faint that I questioned my own sanity – a friend had been recently diagnosed and I thought maybe I was imagining it because those were her symptoms. (Sounds daft now when I write it down!) Anyway, in 2012 when I got full blown optic neuritis again – this time I lost the sight completely in one eye, though it has come back about 90%.
    I eventually got diagnosed after a lumbar puncture in maybe 2013/2014.
    I don’t have any symptoms (apart from the sight loss) and I am not on any DMDs – I am so loathe to take the drugs because the side effects are so much worse than the symptoms I have. I don’t know what to do. I have an annual check-up with my neurologist in the next few months, should I ask for another MRI to see if there has been disease progression or should I take the drugs. I just don’t know what to do.

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  2. "I dont like the drugs but the drugs like me"

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  3. I had my first symptoms in my mid 20s.My first clinically diagnosed relapse was when i was 50 (numb from the waist down). I recovered. I was sold the fairy tale of benign MS. No lesions appeared on my MRI until around age 55 . I only had three diagnosed relapses in a total of 35 years before progression commenced around age 60 . Now I need 2 canes to walk painfully slowly and have other symptoms that severely compromise my quality of life. I would advise anyone who has ha∂ diagnosed symptoms of MS to intervene with medication as early as possible and with the most effective known medication. I dont believe benign MS exists, or else it is pretty rare. But by the time you find out it is not benign you have few options left

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    1. "I only had three diagnosed relapses in a total of 35 years"

      Uaaaaaau

      Thanks for sharing

      Delete

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