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Published on: June 30, 2014
Clinical characteristics of progressive relapsing multiple sclerosis
M J Tullman1, R J Oshinsky, F D Lublin
1Department of Neurology, The Corinne Goldsmith Dickinson Center for Multiple Sclerosis, The Mount Sinai Hospital, New York, NY 10029, USA. mark.tullman@mssm.edu
Objective:
Patients with progressive relapsing (PR) multiple sclerosis (MS) may accrue disability by incomplete recovery from acute exacerbations and by ongoing deterioration. In primary progressive (PP) MS, disability accumulates solely by continuous decline. Because it is the least common form of MS, there is scant information regarding the clinical characteristics of PRMS, but relapses are reportedly uncommon. The purpose of this study is to describe the clinical features of a cohort of patients with PRMS.
Methods:
A retrospective chart review of 16 patients diagnosed with PRMS at two academic MS centres over a four-year period.
Results:
Nine men and seven women had PRMS. The mean age at onset was 35.1+/-11.2 years. The most common presenting symptom was a progressive myelopathy. The mean disease duration was 10.1+/-8.5 years and the average time to first exacerbation was 4.1+/-3.7years. Patients had an average of 2.8+/-2.3 relapses with an annualized relapse rate of 0.6+/-0.8. Time to Expanded Disability Status Scale (EDSS) 6.0 was strongly associated with time to first exacerbation. Although there was no correlation between the number of relapses and time to EDSS 6.0, there was a modest inverse relation between time to EDSS 6.0 and annualized relapse rate.
Conclusions:
Relapses in PRMS may occur more often than previously described and disability may accumulate more rapidly in PRMS than in PPMS. We suggest differentiating between these two forms of MS.
Insights
Progressive relapsing multiple sclerosis (PRMS) patients may experience more frequent relapses and faster disability accumulation than previously thought. This study highlights key clinical features and suggests differentiating PRMS from primary progressive MS.
Area of Science:
- Neurology
- Neuroimmunology
- Clinical Neurology
Background:
- Progressive relapsing multiple sclerosis (PRMS) is characterized by incomplete recovery from exacerbations and ongoing deterioration.
- Primary progressive multiple sclerosis (PPMS) involves continuous disability accumulation.
- Limited data exists on PRMS clinical characteristics, with relapses reportedly infrequent.
Purpose of the Study:
- To delineate the clinical features of a cohort of patients diagnosed with progressive relapsing multiple sclerosis (PRMS).
- To provide insights into the natural history and disease course of PRMS.
Main Methods:
- Retrospective chart review of 16 patients with a PRMS diagnosis.
- Data collected from two academic multiple sclerosis (MS) centers over a four-year period.
- Analysis included age at onset, presenting symptoms, disease duration, relapse rates, and time to disability milestones.
Main Results:
- The cohort comprised nine men and seven women with a mean age at onset of 35.1 years.
- Progressive myelopathy was the most common presenting symptom.
- Patients experienced an average of 2.8 relapses, with an annualized relapse rate of 0.6. Time to Expanded Disability Status Scale (EDSS) 6.0 correlated with time to first exacerbation.
Conclusions:
- Relapses in PRMS may be more frequent than previously reported in the literature.
- Disability accumulation in PRMS might be more rapid compared to PPMS.
- The findings support the need to distinguish PRMS from PPMS for accurate diagnosis and management.
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