The Natural History of Multiple Sclerosis: A Geographically Based Study

Abstract

We used hypothetical entry criteria typical of those used in clinical therapeutic trials to determine the patients who would have been eligible among those followed in a clinic-based study of multiple sclerosis (MS) in London, Ontario, between 1972 and 1984. For these patients, we determined the observed frequency of deterioration by 1 point on the disability status scale (DSS) of Kurtzke, which is the most feasible and frequently used endpoint in clinical trials. We calculated the number of patients required for a randomized clinical trial to detect a significant result (alpha = 0.05) with 80% or 90% power based on the observed rate of deterioration. To assess the linearity of the DSS, we determined the frequency of progression and staying time at each level of the DSS. Overall the frequency of progression was lower and the staying times were longer at higher levels of disability. There was considerable intrapatient as well as interpatient variation in staying time. These data have major implications for the design and conduct of clinical therapeutic trials in MS.

Medical chart validation of an algorithm for identifying multiple sclerosis relapse in healthcare claims

“…Approximately 85% of all people diagnosed with MS begin with RRMS, but 5-15 years later symptoms begin to worsen. By 10 years 50% and by 20-25 years at least 80% of untreated relapsing patients will move into a secondary progressive state with fewer relapses 28,29 . The claims-based algorithm may be more sensitive to identifying the relapses occurring while patients are still in the relapsing-remitting stage of their disease.…”

Spinal cord grey matter abnormalities are associated with secondary progression and physical disability in multiple sclerosis

“…Relapse-onset multiple sclerosis (MS) presents as a clinically isolated syndrome (CIS), later evolving to relapsing-remitting (RR) MS and, in many cases, secondary progressive (SP) MS 1. Physical disability in SPMS is often due to a progressive spinal cord syndrome 2.…”

Utilisation and cost of professional care and assistance according to disability of patients with multiple sclerosis in Flanders (Belgium)

“…In a minority of patients the disease is progressive from the onset. The mean time to reach a disability requiring aids for ambulation is 15 years 1. Survival after onset in high risk areas is in the order of 35 to 40 years 2…”