Objective:
To study a subset of multiple sclerosis (MS) patients with long-term clinically benign disease course.
Background:
Current understanding is that leaving MS untreated or providing minimal treatment can lead to long-term disability. However, aggressive treatment strategy for MS does carry potential risks of immunosuppression and may not be essential for every patient. In this study, we analyze data from individuals diagnosed with clinically definite MS for a minimum of 20 years to better define the clinical entity of benign MS (BMS).
Design/Methods:
In this retrospective cohort study we assessed clinical records from 1,520 consecutive patients under the care of a single neurologist at the Tisch MSRCNY. Patients were selected based on the following criteria to designate a benign disease course : disease duration of at least 20 years with no clinical relapses, an EDSS score after at least 20 years of disease duration of less than 3, and stable MRI findings. All patients either received no treatment or were treated with a single usually low efficacy disease-modifying therapy (DMT). All patients met the definition of clinically definite MS.
Results:
Of the total patient population, 265 met the criteria for BMS (17.4%). Of these BMS patients, 211 were female (79.6%) and 54 were male (20.4%). Approximately 62.6% were treated with a single disease-modifying medication. The average age at disease onset was 33.7, and the average duration of disease was 22.6 years. None of the BMS patients had significant cognitive impairment, cerebellar dysfunction or spasticity at disease onset.
Conclusions:
Recently the trend has been to treat all RRMS patients aggressively in order to minimize future disability. This study emphasizes that BMS should be considered as an entity in a subgroup of MS patients . It also emphasizes that therapeutic decisions should be individual patient based and not generalized and pre-determined.