The Natural History of Multiple Sclerosis: A Geographically Based Study

Weinshenker, Brian G.; Rice, George P.; Noseworthy, John H.; Carriere, W.; Baskerville, J.; Ebers, G. C.

doi:10.1093/brain/114.2.1045

Cited by 381 publications

(87 citation statements)

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“…On the other hand, male gender, older age at onset, PP onset and onset with motor LT dysfunction or a combination of symptoms were associated with relatively more severe disease and shorter time to disability. These results are in agreement with previous studies [5,6,17]. It should be noted, however, that the present findings have methodological limitations.…”

Section: Discussionsupporting

confidence: 93%

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The Onset of Multiple Sclerosis in Greece: A Single-Center Study of 1,034 Consecutive Patients

et al. 2010

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Background/Aims: The onset of multiple sclerosis (MS) in Greece has not been systematically studied. We sought to provide data on the onset of MS in Greece with detailed information regarding initial symptoms, and to confirm the prognostic significance of demographic and clinical factors at onset. Methods: We studied 1,034 consecutive patients with MS and independently assessed 265 patients ‘seen at onset’. We used the MS severity score and survival analysis (time to reach an Expanded Disability Status Scale score of 4.0) to evaluate the prognostic significance of factors at onset. Results: Female-to-male ratio was 1.9:1 and mean age at onset was 30.7 ± 9.9 years. MS was primary progressive in 9.6%. Initial symptoms were optic neuritis in 20.1%, brainstem dysfunction in 14.7%, dysfunction of long tracts in 49.3%, cerebral dysfunction in 1% and a combination of symptoms in 14.9%. In ‘seen at onset’ patients, detailed data on initial symptoms are presented. Female gender, earlier age at onset, ‘bout onset’ and onset with optic neuritis were associated with less severe disease and longer time to disability. Conclusion: The onset of MS in Greece is similar to Western populations. Initial symptoms are within the expected spectrum. Prognostic significance of factors at onset is as previously identified.

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Section: Discussionsupporting

confidence: 93%

“…We have provided detailed information regarding presenting symptomatology in this subgroup, given the relative scarcity of such data in the recent literature. We have also attempted to verify demographic and clinical variables at onset known to influence prognosis from previous studies [5,6,17]. …”

Section: Introductionmentioning

confidence: 99%

The Onset of Multiple Sclerosis in Greece: A Single-Center Study of 1,034 Consecutive Patients

et al. 2010

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“…In most studies, it has been found that less than 10% of all patients have late-onset MS (LOMS), defined as disease onset on or after age 50 [1]. Although LOMS is considered to be associated with adverse prognosis [2,3,4,5], whether it has any prognostic relevance independent of primary progressive MS (PPMS), an established marker of poor prognosis strongly associated with older age at onset, remains a debatable issue [6,7,8,9]. Age at disease onset was an independent predictor of early progression to disability only in relapsing-remitting onset MS (RRMS) but not in PPMS in a cohort of 2,054 patients [10], while older age was independently associated with short time to disability in a cohort of 500 PPMS patients [11].…”

Section: Introductionmentioning

confidence: 99%

Older Age at Multiple Sclerosis Onset Is an Independent Factor of Poor Prognosis: A Population-Based Cohort Study

Guillemin

Baumann²,

Epstein³

et al. 2017

Neuroepidemiology

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Background: Late-onset multiple sclerosis (LOMS) frequently features a primary progressive (PP) course, strongly predicting severe disability. In this population-based cohort, we estimated the prognostic role of age at multiple sclerosis (MS) onset, independent of PP course, on disability progression. Methods: The association of age at disease onset (adult, <50 years [AOMS], vs. late, ≥50 years [LOMS]) and time to Expanded Disability Status Scale (EDSS) score 4 and 6 was estimated by Cox regression modelling. Results: Among 3,597 patients, 245 had LOMS. Relapsing-remitting (RR) disease was less frequent with LOMS than AOMS (51.8 vs. 90.8%, p < 0.0001). PP course, LOMS and male gender predicted short time to EDSS 4 and 6. Worse outcome with LOMS (time to EDSS 4 and 6, HR 2.0 [95% CI 1.7-2.4] and 2.3 [1.9-2.9]) was independent of PP course or male gender. LOMS had greater impact on RR than PP disease (time to EDSS 4 and 6, HR 3.1 [2.3-4.0] and 4.0 [2.9-5.6]). Only LOMS predicted time from EDSS 4 to 6 (p < 0.0001). Conclusions: Late onset MS was strongly associated with poor prognosis, independent of initial disease course, in predicting the disability progression along time.

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“…Gender, age at onset, course at onset, degree of recovery from the first relapse, time to second relapse and the number of relapses in the first years affect the time from onset to EDSS 4 or 6 [21,22]. Male gender, older age at onset and progressive onset MS are predictors of an unfavorable outcome [23]. …”

Section: General Introduction On Multiple Sclerosismentioning

confidence: 99%

Female Gender and Reproductive Factors Affecting Risk, Relapses and Progression in Multiple Sclerosis

D’hooghe

D’Hooghe²,

Keyser

2013

Gynecol Obstet Invest

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Multiple sclerosis (MS), a chronic inflammatory demyelina-ting and degenerative disease of the central nervous system, is a frequent cause of neurological disability in young adults. Female predominance has increased over the last decades. Although female gender carries a higher risk of developing relapsing remitting MS, being female and at child-bearing age also appears to provide some protection against cognitive decline and against progressive onset MS, an adverse predictive factor when considering long-term disability in MS. The risk of MS in women has been associated with an earlier age at menarche. In most studies, parity did not impact MS risk. However, the recently published association of higher parity and offspring number with a reduced risk of a first demyelinating event suggests a potential suppressive effect. Pregnancy in MS patients has been associated with a reduced relapse rate and a reduction of neurological symptoms, especially in the third trimester. Despite the increased relapse risk in the postpartum period, there is no indication of an adverse effect of childbirth on the long-term course of MS. Fertility treatment in MS has been associated with an increased relapse risk in the following 3-month period, especially when the procedure did not result in pregnancy and gonadotrophin-releasing hormone agonists were used. Altogether, there is substantial evidence to support a regulatory role of sex steroid hormones in MS. In the absence of correlations with single hormone blood levels, we can only speculate about the underlying mechanisms. In conclusion, the increased MS risk in women and the changes in relapse and progression risk in association with reproductive events suggest significant and complex interactions between immune, neuroendocrine and reproductive systems in MS.

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The Natural History of Multiple Sclerosis: A Geographically Based Study

Cited by 381 publications

References 0 publications

The Onset of Multiple Sclerosis in Greece: A Single-Center Study of 1,034 Consecutive Patients

The Onset of Multiple Sclerosis in Greece: A Single-Center Study of 1,034 Consecutive Patients

Older Age at Multiple Sclerosis Onset Is an Independent Factor of Poor Prognosis: A Population-Based Cohort Study

Female Gender and Reproductive Factors Affecting Risk, Relapses and Progression in Multiple Sclerosis

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