Benign multiple sclerosis: a new definition of this entity is needed

Area of Science:

• Neurology
• Neuroimmunology
• Clinical Neuroscience

Background:

• Benign multiple sclerosis (BMS) is often defined by minimal physical disability.
• Longitudinal studies are needed to understand the full spectrum of BMS beyond physical limitations.

Purpose of the Study:

• To evaluate cognitive, social, and non-motor symptoms in a cohort of BMS patients.
• To assess changes in MRI findings over time in BMS patients.
• To determine the long-term disease course of patients meeting BMS criteria.

Main Methods:

• Prospective follow-up of 342 patients for approximately 11 years.
• Detailed assessment of 43 patients meeting BMS criteria (EDSS < 3 after 10 years).
• Yearly evaluations included neurological exams, neuropsychological testing, pain, fatigue, social functioning, and brain MRI.

Main Results:

• Over 80% of BMS patients showed worsening cognitive function, fatigue, pain, or depression.
• Significant increases in new or enlarging T2 lesions and other MRI abnormalities were observed in 74% of patients.
• Cognitive impairment (47%), depression (53.3%), and changes in pain (48.8%) were prevalent.

Conclusions:

• Current BMS diagnostic criteria may overestimate prevalence.
• Routine monitoring of non-motor symptoms and MRI is essential for accurate diagnosis.
• Improved diagnostic accuracy and therapeutic decisions are needed for this MS subgroup.