Course and possible prognostic predictors were studied retrospectively in 363 MS patients collected during an epidemiological study. The proportion of patients showing a primarily progressive course was 18%; 19% of patients of more than 10 years duration showed a benign course, and 8% of those of less than 16 years duration, a malignant course. Although benign cases were twice as frequent in females as in males, the difference between both sexes was not significant. A primarily or secondarily progressive course, a high number of functional systems involved and cerebellar signs occurring in the course indicated a poor prognosis whereas symptoms at onset, age at onset as such, and occupation were without predictive value. No predictors of a favourable course were found. Of the patients of 11-15 years duration, 17% were confined to a wheelchair, 40% were restricted to a walking distance of 500 metres or less, 61% were unable to work and 45% had urinary incontinence. The corresponding figures for those of 21-25 years duration were 40%, 71%, 76% and 50%.
The influence of sex, age at onset, course of the disease and initial symptomatology on the mortality of patients with multiple sclerosis is analysed. A sample of 1926 patients was followed up prospectively over 4.9 years. Both, the mortality ratio (number of observed to expected deaths) and the excess death rate are calculated. Whereas the mortality ratio as a parameter of overall mortality is influenced by a variety of factors, such as age and sex; the excess death rate represents the number of extra deaths per 1000 exposed to risk in an indicated year and is, therefore, a parameter of the mortality which is attributed to MS. The excess death rate was comparable for the sexes, it was slightly higher for patients with a higher age at onset and it was clearly higher for the progressive course. Patients with initial diplopia and sensory signs and symptoms had the lowest excess death rate, whereas patients with pareses, cerebral and sphincter disturbances at onset showed the highest excess death rate.
Epidemiological data of 931 patients with definite and probable multiple sclerosis in four areas in Europe (Groningen, Göttingen, Darmstadt and Baranya) were collected and compared. The same criteria and scoring methods were used. Clear differences between the areas appeared: a high percentage of severely disabled patients were encountered in the northern part (Groningen) and a high percentage of signs and symptoms related to supraspinal lesions in brainstem, cerebellum and hemispheres were found in the south east (Hungary). In Göttingen, in the central part of the total area, a relatively higher percentage of younger MS patients with minimal disability were found. However, it still has to be determined to which extent these differences are real or caused by information bias.
Demographic and clinical features and data on medical history and prior environmental exposure collected during an epidemiological long-term study of multiple sclerosis (MS) were tested for their possible prognostic value. Fifty-two benign MS patients were compared with 29 patients having a malignant course. A primary or secondary progressive course and cerebellar/lower brain-stem symptoms at onset indicated an unfavourable course, whereas no predictive value of sex or of any other type of onset symptomatology was found. Age at onset per se had no influence on prognosis but was associated with more rapid progression only by its relationship with a chronic progressive type of course. Prior illness, surgery, trauma and childhood exposure to defined environmental factors could not be identified as relevant for prognosis.
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