SURVIVAL AND PREDICTORS OF DISABILITY IN TURKISH MS PATIENTS

Objective: To examine the natural history, survival, and prognostic fa ctors in a sample of Turkish MS patients. Method: This multicenter stu dy included 1,259 definite MS patients diagnosed according to the crit eria of Poser et al. Actuarial analysis of selected disability levels of 3, 6, 8, and 10 achieved with the Expanded Disability Status Scale (EDSS); a multivariate Cox regression analysis for prognostic factors related to time to reach EDSS greater than or equal to 6; and Pearson' s correlation coefficient for individual factors were performed. Resul ts: The survival (+/- SE) at 15 years from onset was 94.6 +/- 2.9%, an d at 25 years was 89.0 +/- 5.8%. The disability reached by 15 years wa s EDSS greater than or equal to 3 in 66.4%, EDSS greater than or equal to 6 in 41.2%, EDSS greater than or equal to 8 in 10.5%, and EDSS = 1 0 in 5.4%. The most significant unfavorable prognostic factors were pr ogressive course (relative risk [RR], 3.73; CI, 2.71 to 5.13) and sphi ncter symptoms at onset (RR, 1.86; CI, 1.23 to 2.82), followed by male sex, motor symptoms at onset, and a high attack frequency within the first 5 years. Primary progressive disease was correlated positively w ith male sex (r = 0.0895, p = 0.001), older age (I = 0.1807, p = 0.000 ), and motor (r = 0.1433, p = 0.000) or sphincter symptoms (r = 0.1001 , p = 0.000) at onset, unlike relapsing-remitting and secondary progre ssive disease. Conclusions: Although a slightly better prognosis is ob served in the Turkish MS population, early prognostic factors are simi lar to most of the previous Western series. Primary progressive diseas e, mostly seen in older men with motor and sphincter involvement at on set, has a worse prognosis and may represent a distinct behavioral var iant of MS.