Factors predicting incomplete recovery from relapses in multiple sclerosis: a prospective study.

Clinica Neurologica,

Ospedale Maggiore della Carità,

Novara, Italy and

Interdisciplinary Research Center of Autoimmune Diseases (IRCAD),

Novara, Italy.

Objective

To prospectively evaluate predictors of incomplete recovery after the first attacks in a cohort of patients with clinically isolated syndrome or relapsing-remitting multiple sclerosis. 

Methods

Seventy-two consecutive patients recruited from January 2001 to December 2003, evaluated every six months or at any relapse up to 31 July 2005.

Relapse intervals were calculated from the date of onset, nadir, onset of improvement and maximum improvement.  

Predictive factors analysed were

relapse-related (age at relapse onset, season and severity of the relapse,

type of symptoms,

speed of onset,

plateau, and

total duration,

number of affected.  

Functional systems, preceding infections, and individual-related (gender, age at first attack, season of birth and first attack, characteristics of first brain MRI and cerebrospinal fluid oligoclonal bands, Link Index, IgG).

Results

We counted 209 attacks:

o     44 (21%) left mild sequelae, and

o     27 (13%) severe.

The highest probability of sequelae was associated with sphincteric symptoms (9/20; 45%),

followed by sensitive(38/113; 34%),

o     motor (20/84; 24%),

o     visual (13/61; 21%),

o     cerebellar (4/24; 17%),

o     brainstem (5/44;11%) and

o     others (0/6) (P _ 0.005).

Four variables were still relevant to predict sequelae after multivariate analysis: mild, moderate, or severe relapses versus very mild (Odds ratio _ 17.2, 95% confidence limits _ 2.2-136.4), intermediate or long relapses versus short (3.2, 1.5-6.9), age _ 30 at relapse onset (2.9, 1.5-5.7) and bi-poly-symptomatic versus mono-symptomatic (2.2, 1.1-4.3).

Conclusions