Early determinants of long-term outcomes in multiple sclerosis

Area of Science:

• Neurology
• Immunology
• Epidemiology

Background:

• Multiple sclerosis (MS) presents diverse clinical courses, with predictors of long-term disability progression needing further elucidation.
• Individualized patient management requires identification of demographic and clinical factors influencing disease trajectory.

Purpose of the Study:

• To examine demographic, clinical, and laboratory factors affecting disability progression and relapse patterns in a large Turkish MS cohort.
• To analyze over two decades of patient data for insights into MS disease dynamics.

Main Methods:

• Retrospective analysis of 1580 MS patients (2017 McDonald criteria) followed from 1980-2020.
• Survival analysis for Expanded Disability Status Scale (EDSS) milestones (3 and 6).
• Logistic regression to identify predictors of progressive MS.

Main Results:

• Male sex and lower educational attainment correlated with accelerated disability accumulation (p < 0.005 and p < 0.001).
• Motor, cerebellar, and spinal onset predicted a progressive phenotype; optic neuritis, sensory, and brainstem onset indicated a relapsing-remitting course.
• Smoking, family history, and oligoclonal band (OCB) positivity did not impact disability progression. Inter-relapse intervals stabilized after the fifth relapse.

Conclusions:

• Distinct demographic and clinical factors predict MS progression in the long term.
• Early disability accumulation (pre-EDSS 3) is crucial for determining long-term outcomes.
• Aggressive early therapeutic intervention is vital to modify MS progression trajectory.