MS Progresses Slowly for Most Patients

Most People With Multiple Sclerosis Remain Stable Over 10-Year Follow-up

From the WebMD Archives

Jan. 27, 2004 -- New research should help change the common public perception of multiple sclerosis as an always rapidly progressing condition that more often than not leaves its patients in wheelchairs.

In the most comprehensive study of how multiple sclerosis progresses ever conducted, Mayo Clinic researchers found that most patients did not progress to a disability in walking over a 10-year observation period.

Of the patients in the study who were minimally disabled when first examined in 1991, the majority 83%, could still walk without a cane at the end of a 10-year follow-up period.

"The fact that most MS patients don't get progressively worse over 10 years is the really great news," says Moses Rodriguez, MD, who led the Mayo Clinic research team.

Natural Progression

Of the 162 MS patients living in Olmsted County, Minnesota, who were examined in 1991, all but one was included in the follow-up 10 years later. Researchers used a standardized, 10-point multiple sclerosis evaluation scale to assess disabilities.

The study effectively measured the natural progression of multiple sclerosis. Only a few of the patients had been treated with disease-modifying therapy, such as drugs like interferon.

"Because so many patients are being treated now, this may be the last time we can really assess the natural history of this disease," researcher Sean J. Pittock, MD, tells WebMD.

Roughly one in three patients progressed to a more disabling state -- such as walking with a cane or using a wheelchair -- over the 10 year follow-up.

The researchers found that once a disability appeared, progression of the disease to requirement of a cane or wheelchair was likely.

Patients with more moderate or severe disability scores at the beginning of the study were at a higher risk of developing impaired walking at follow-up.

The findings are published in the January issue of the journal Neurology.

In another study, Pittock and colleagues found that the progression of symptoms during the first five years following a diagnosis of multiple sclerosis is a good predictor of whether the disease will progress quickly or slowly.

"A patient with minimal disability after five years will have about a 90% chance of continuing to have minimal disability over the next decade or so," he says. "Some patients do progress to the point where they need a wheelchair very quickly, but for most multiple sclerosis patients the outlook is better than they may think."

Changing View of MS

National Multiple Sclerosis Society spokesman Stephen Reingold, PhD, tells WebMD that the findings will come as no surprise to doctors who treat MS patients, but they may help change the public's perception of the disease.

"There are a large number of people walking around with MS who are functioning perfectly normally," he says. "The public needs to know that this is a disease with a broad spectrum of severity. Patients can have very serious and disabling symptoms or almost no symptoms at all."

But he adds that the vast majority of patients with multiple sclerosis will eventually experience some degree of disease-related disability. Reingold serves as vice president for research for NMSS.

"This is a progressive, neurologic disease, and people do tend to get worse over time," he says. "But this study confirms that for the majority of patients, progression is slow."

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SOURCES: Pittock, S. Neurology, January 2004; vol 63: pp 51-59. Moses Rodriguez, MD, and Sean J. Pittock, MD, department of neurology, Mayo Clinic, Rochester, Minn. Stephen Reingold, PhD, vice president for research, National MS Society.
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