Hostname: page-component-745bb68f8f-mzp66 Total loading time: 0 Render date: 2025-01-28T04:57:00.064Z Has data issue: false hasContentIssue false
  • English
  • Français

The Natural History of Multiple Sclerosis

Published online by Cambridge University Press:  18 September 2015

B.G. Weinshenker  and
G.C. Ebers
B.G. Weinshenker
Affiliation:
Department of Clinical Neurological Sciences, University of Western Ontario, London
G.C. Ebers*
Affiliation:
Department of Clinical Neurological Sciences, University of Western Ontario, London
*
Department of Clinical Neurological Sciences, University Hospital, P.O. Box 5339, London, Ontario, Canada N6A 5A5
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Studies which have attempted to define the outcome of multiple sclerosis (MS) have methodologic difficulties arising from patient referral biases and the length of follow-up required, which make prospective studies of an inception cohort unrealistic. Means to improve the validity of retrospective natural history studies are suggested. Results of existing series are summarized and compared. Survival is only rarely shortened by MS, but disability to the point of requiring aids for ambulation occurs in 30-70% of patients by 15 years from onset of symptoms. Disagreement as to the percentage of patients who are ultimately bedridden by MS likely arises in large part due to differences in patient ascertainment and follow-up. The need to develop early clinical markers for the patient at high risk for rapid development of major disability is stressed.

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 14 , Issue 3 , August 1987 , pp. 255 - 261
Copyright
Copyright © Canadian Neurological Sciences Federation 1987

References

REFERENCES

1.Noseworthy, JH, Seland, TP, Ebers, GC, Therapeutic trials in multiple sclerosis. Can J Neurol Sci 1984; 2: 355–62.CrossRefGoogle Scholar
2.Kurtzke, JF. Symptomatology of Multiple Sclerosis. In: Vinken, PJ, Bruyen, GW.Klawans, HL. eds. Handbook of Clinical Neurology. Vol9, Amsterdam: ElsevierSciencePublishingCo, 1971; 186–216.Google Scholar
3.Poser, S. Multiple Sclerosis. An analysis of 812 cases by means of electronic data processing. Berlin: Springer- Verlag, 1978; 54–66.Google ScholarPubMed
4.Sackett, DL, Haynes, RB, Tugwell, P. Clinical Epidemiology. A Basic Science for Clinical Medicine. Boston: Little, Brown & Co, 1985;Google Scholar
5.Lazarte, JA. Multiple sclerosis: Prognosis for ambulatory and nonambulatory patients. Assoc Res Nerv Dis Proc 1950; 28: 512–23.Google ScholarPubMed
6.McAlpine, D, Compston, N, Some aspects of the natural history of disseminated sclerosis. Quart J Med 1952; 21: 135–67.Google ScholarPubMed
7.Muller, R, Studies on disseminated sclerosis with special reference to symptomatology, course and prognosis. Acta Med Scand 1949; Supp 2221–214.Google Scholar
8.Poser, S, Bauer, HJ, Poser, W. Prognosis of multiple sclerosis. Results from an epidemiological area in Germany. Acta Neurol Scand 1982; 65: 347–54.CrossRefGoogle ScholarPubMed
9.Gilbert, JJ, Sadler, M, Unsuspected multiple sclerosis. Arch Neurol 1983; 40: 535–36.CrossRefGoogle ScholarPubMed
10.McAlpine, D. The benign form of multiple sclerosis. A study based on 241 cases seen within three years of onset and followed up until the tenth year or more of the disease. Brain 1961; 84: 186–203.CrossRefGoogle ScholarPubMed
11.Kurtzke, JF, Beebe, GW, Nagler, B, et al. Studies on the natural history of multiple sclerosis VIII. Early prognostic features of the later course of the illness. J Chron Dis 1977; 30: 819–30.CrossRefGoogle Scholar
12.Visscher, BR, Liu, KS, Clark, VA, et al. Onset symptoms as predictors of mortality and disability in multiple sclerosis. Acta Neurol Scand 1984; 70: 321–28.CrossRefGoogle ScholarPubMed
13.Clark, VA, Detels, R. Visscher, BR, et al. Factors associated with a malignant or benign course of multiple sclerosis. JAMA 1982; 248: 856–60.CrossRefGoogle ScholarPubMed
14.Detels, R, Clark, VA, Valdiviezo, NL, et al. Factors associated with a rapid course of multiple sclerosis. Arch Neurol 1982; 39: 337–41.CrossRefGoogle ScholarPubMed
15.Confavreux, C, Aimard, G, Devic, M. Course and prognosis of multiple sclerosis assessed by the computerized data processing of 349 patients. Brain 1980; 103: 281–300.CrossRefGoogle ScholarPubMed
16.Leibowitz, U, Halpern, L, Alter, M. Clinical studies of multiple sclerosis in Israel. Arch Neurol 1964; 10: 502–12.CrossRefGoogle ScholarPubMed
17.Leibowitz, U, Alter, M, Halpern, L, Clinical studies of multiple sclerosis in Israel III: Clinical course and prognosis related to age at onset. Neurology 1964; 14: 926–32.CrossRefGoogle Scholar
18.Leibowitz, U, Alter, M. Clinical factors associated with increased disability in multiple sclerosis. Acta Neurol Scand 1970; 46: 53–70.CrossRefGoogle ScholarPubMed
19.Gudmundsson, KR, Clinical studies of multiple sclerosis in Iceland- a follow-up of previous survey and reappraisal. Acta Neurol Scand 1971; 47 (Suppl 48): 1–53.Google Scholar
20.Patzold, U, Pocklington, PR, Course of multiple sclerosis: First results of a prospective study carried out of 102 MS patients from 1976-1980. Acta Neurol Scand 1982; 65: 248–66.CrossRefGoogle ScholarPubMed
21.Fog, T, Linnemann, F, The course of multiple sclerosis in 73 cases with computer designed curves. Acta Neurol Scand 1970; 46 (Suppl 47): 1–175.Google Scholar
22.Panelius, M, Studies on epidemiological, clinical and etiological aspects of multiple sclerosis. Acta Neurol Scand 1969; 45 (Suppl 39): 1–82.Google Scholar
23.Thompson, AJ, Hutchinson, M, Brazil, J, et al. A clinical and laboratory study of benign multiple sclerosis. Quart J Med 1986; 58: 69–80Google ScholarPubMed
24.Broman, T, Andersen, O, Bergmann, L. Clinical studies on multiple sclerosis I. Presentation of an incidence material from Gothenburg. Acta Neurol Scand 1981; 63: 6–33.CrossRefGoogle ScholarPubMed
25.Kurtzke, JF, On the evaluation of disability in multiple sclerosis. Neurology 1961; 11: 686–94.CrossRefGoogle ScholarPubMed
26.Kurtzke, JF. Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS). Neurology 1983; 33: 1444–52.CrossRefGoogle ScholarPubMed
27.Verjans, E, Theys, P, Delmotte, P, et al. Clinical parameters and intrathecal lgG synthesis as prognostic features in multiple sclerosis. Part 1. J Neurol 1983; 229: 155–65CrossRefGoogle Scholar
28.Poser, S, Raun, NE, Poser, W. Age at onset, initial symptomatology and the course of multiple sclerosis. Acta Neurol Scand 1982; 66: 355–62.CrossRefGoogle ScholarPubMed
29.Noseworthy, JH, Paty, DW, Ebers, GC. Neuroimaging in multiple sclerosis. Neurologic Clinics 1984; 2: 759–77.CrossRefGoogle ScholarPubMed
30.Johnson, MA, Li, DKB, Bryant, DJ, et al. Magnetic resonance imaging: Serial observations in multiple sclerosis. AJNR 1984; 5: 495–99.Google ScholarPubMed
31.Stevens, JC, Farlow, MR, Edwards, MK, et al. Magnetic resonance imaging: Clinical correlation in 64 patients with multiple sclerosis. Arch Neurol 1986; 43: 1145–48.CrossRefGoogle ScholarPubMed
32.Matias-Guiu, J, Sanz, M, Gili, J, et al. Correlation of MRI with the clinical status of patients with multiple sclerosis. Neurology 1986; 36: 1626.CrossRefGoogle ScholarPubMed
33.Paty, DW, Palmer, M, Bergstrom, M, et al. Magnetic resonance imaging in multiple sclerosis: Quantitative changes in the size of lesions over 6 months in the placebo limb of a therapeutic trial. Can J Neurol Sci 1986; 13: 168.Google Scholar
34.Kurtzke, JF, Auth, TL, Beebe, GW, et al. Survival in multiple sclerosis. Trans Am Neurol Assoc 1969; 94: 134–39.Google ScholarPubMed
35.Percy, AK, Nobrega, FT, Okazaki, H, et al. Multiple sclerosis in Rochester, Minn. Arch Neurol 1971; 25: 105–11.CrossRefGoogle ScholarPubMed
36.Leibowitz, U, Kahana, E, Alter, M. Survival and death in multiple sclerosis. Brain 1969; 92: 115–30.CrossRefGoogle ScholarPubMed
37.Schumacher, GA, Beebe, G, Kiblett, RF, et al. Problems of experimental trials of therapy in multiple sclerosis; report by the Panel on the Evaluation of Experimental Trials of Therapy in Multiple Sclerosis. Ann NY Acad Sci 1965; 122: 552–68.CrossRefGoogle Scholar
38.Poser, CM, Paty, DW, Scheinberg, L, et al. New diagnostic criteria for multiple sclerosis: Guidelines for research protocols. In: Poser, CM, ed. The Diagnosis of Multiple Sclerosis. New York: Thieme-Stratton lnc, 1984; 225–29.Google Scholar
39.Noseworthy, J, Paty, D, Wonnacott, T, et al. Multiple sclerosis after age 50. Neurology 1983; 33: 1537–44.CrossRefGoogle ScholarPubMed
40.Engell, T, Raun, NE, Thomsen, M, et al. HLA and heterogeneity of multiple sclerosis. Neurology 1982; 32: 1043–46.CrossRefGoogle ScholarPubMed
41.Meyer-Rienecker, HJ, Wegener, S, Hitzschke, B, et al. Multiple sclerosis-relation between HLA haplotype A25, B18 and disease progression. Acta Neurol Scand 1982; 66: 709–12.CrossRefGoogle ScholarPubMed
42.Madigand, M, Oger, JJ, Fauchet, R, et al. HLA profiles in multiple sclerosis suggest two forms of disease and the existence of protective haplotypes. J Neurol Sci 1982; 53: 519–29.CrossRefGoogle ScholarPubMed
43.Poser, S, Ritter, G, Bauer, HJ, et al. HLA antigens and the prognosis of multiple sclerosis. J Neurol 1981; 225: 219–21.CrossRefGoogle ScholarPubMed