7. Predicting Clinical Course

  1. Howard L. Weiner MD4,5,6 and
  2. James M. Stankiewicz MD4,5
  1. Brian Healy PhD1,5 and
  2. Maria Liguori MD, PhD1,2,3

Published Online: 23 FEB 2012

DOI: 10.1002/9781119963714.ch7

Multiple Sclerosis: Diagnosis and Therapy

Multiple Sclerosis: Diagnosis and Therapy

How to Cite

Healy, B. and Liguori, M. (2012) Predicting Clinical Course, in Multiple Sclerosis: Diagnosis and Therapy (eds H. L. Weiner and J. M. Stankiewicz), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781119963714.ch7

Editor Information

  1. 4

    Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA

  2. 5

    Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA

  3. 6

    Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, MA, USA

Author Information

  1. 1

    Department of Neurology, Harvard Medical School, Boston, MA, USA

  2. 2

    National Research Council, Institute of Neurological Sciences, Mangone, Italy

  3. 3

    Laboratory for Neuroimaging Research, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, MA, USA

  4. 5

    Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA

Publication History

  1. Published Online: 23 FEB 2012
  2. Published Print: 6 APR 2012

ISBN Information

Print ISBN: 9780470654637

Online ISBN: 9781119963714

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Keywords:

  • Clinically isolated syndrome;
  • disease progression;
  • primary progressive MS;
  • relapsing-remitting MS;
  • secondary progressive MS

Summary

In this chapter we describe predictors of clinical course in patients with multiple sclerosis (MS). Several demographic and clinical characteristics are associated with poor disease course, but the type of MS onset is the best predictor of subsequent disability since patients with relapsing onset MS have a more favorable disease course than those with progressive onset MS. Two important disease landmarks for patients with relapsing-onset MS are conversion from a clinically isolated syndrome (CIS) to clinically definite relapsing-remitting MS (RRMS) and the conversion from RRMS to secondary progressive MS (SPMS), and predictors of time to each landmark have been identified. Presence of lesions on a brain MRI is an excellent predictor of conversion from CIS to RRMS, and several specific lesion types are particularly associated with MS. The main predictors of conversion from RRMS to SPMS include features of the initial disease course/relapse characteristics as well as age at onset. Although these predictors allow comparison of groups of patients with specific characteristics, prediction of disease course for individual patients, especially in terms of disease progression, remains challenging. The advent of disease modifying therapy has improved clinical course for patients by reducing the relapse rate and increasing the time from CIS to RRMS, but the effect of these treatment on conversion to SPMS is less clear. Overall, many predictors of disease course in MS patients have been found, but additional studies are needed to improve prediction for individual patients.