ClinicSpeak: benign MS is a misnomer

Should we stop using the term benign MS? #ClinicSpeak #MSBlog #MSResearch

"The study below on benign MS illustrates a point that we have made many times before; benign MS is a very difficult call. A significant proportion of benign MSers have cognitive impairment and associated fatigue, depression and anxiety. Therefore is it correct to simply call someone as having benign disease based on the EDSS, when the EDSS is not a very good way of capturing the impact of MS early on? To diagnose someone as having benign MS is very difficult; it can only be done retrospectively after you have had the disease for 15 years or longer. Even after  waiting 15 years to diagnose MS the majority of people with benign disease will end up acquiring disability over time."

"The good news is that most of what we know about benign MS comes from natural history studies and with new and emerging treatments and treatment strategies (treat-2-target of NEDA) the proportion of MSers with benign disease will increase. It is our treatment aim to make everyone with MS have benign disease."

Epub: Gajofatto et al. Benign multiple sclerosis: physical and cognitive impairment follow distinct evolutions. Acta Neurol Scand. 2015 May 26. doi: 10.1111/ane.12442.

BACKGROUND: Benign multiple sclerosis (BMS) definitions rely on physical disability level but do not account sufficiently for cognitive impairment which, however, is not rare.

OBJECTIVE: To study the evolution of physical disability and cognitive performance of a group of MSers with BMS followed at an University Hospital Multiple Sclerosis Center.

METHODS: A consecutive sample of 24 BMS cases (diagnosis according to 2005 McDonald's criteria, relapsing-remitting course, disease duration ≥10 years, and expanded disability status scale [EDSS] score ≤2.0) and 13 sex- and age-matched non-BMS patients differing from BMS cases for having EDSS score 2.5-5.5 were included. Main outcome measures were as follows: (i) baseline and 5-year follow-up cognitive impairment defined as failure of at least two tests of the administered neuropsychological battery; (ii) EDSS score worsening defined as confirmed increase ≥1 point (or 0.5 point if baseline EDSS score = 5.5).

RESULTS: At inclusion, BMS subjects were 41 ± 8 years old and had median EDSS score 1.5 (range 0-2), while non-BMS patients were 46 ± 8 years old and had median EDSS score 3.0 (2.5-5.5). At baseline 16% of patients in both groups were cognitively impaired. After 5 years, EDSS score worsened in 8% of BMS and 46% of non-BMS patients (P = 0.008), while the proportion of cognitively impaired subjects increased to 25% in both groups.

CONCLUSIONS: MSers with BMS had better physical disability outcome at 5 years compared to non-BMS cases. However, cognitive impairment frequency and decline over time appeared similar. Neuropsychological assessment is essential in MSers with BMS given the distinct pathways followed by disease progression in cognitive and physical domains.

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