Poor recovery after the first two attacks of multiple sclerosis is associated with poor outcome five years later

Examine the relative importance of several risk factors for progression, in a large sample of MS patients.

Using a retrospective design in a single university-based MS treatment center, we studied 207 patients with relapsing remitting MS diagnosed, treated at our center, evaluated within one year of their second attack, and at least 2 years after their first attack. Risk factors were: 1) age greater than 40 at first attack; 2) more than 2 attacks in the 2 years from onset; 3) EDSS >1.5 after second attack (poor recovery); 4) male gender; and 5) motor symptoms at onset. Groups were defined as having a few (0 to 2) or many (3 to 5) risk factors.

Two hundred seven patients were followed for an average of 94 months (SD=44). 30% were over 40 years of age at onset, 38% had more than 2 attacks in 2 years, 28% had an EDSS >1.5 after the second attack (i.e., had poor recovery), 24% were male, and 58% had motor symptoms at onset. Regression analysis and Kaplan-Meier survival curves that suggested poor recovery after the first two attacks were the best individual predictors of progression at 5 years after initial diagnosis. In addition, having many individual risk factors was associated with having a higher risk of progression (p<.001 by Mann Whitney U, sustained final EDSS at an average disease duration of 9.7 years).

This study suggests a paramount importance of recovery from early attacks, as well as an additive effect of individual risk factors for progression of MS in the first several years after diagnosis.