Prognostic factors for survival in multiple sclerosis

In a hospital-based study of 119 Patients with definite multiple sclerosis, demographic and clinical factors were analysed with respect to their valid ity in assessing the long-term prognosis. Over a mean follow-up of 21.7 vee rs, the following factors negatively influenced the prognosis by the univar iate analysis: male sex, age at onset over 25, pyramidal involvement or spa sticity at onset, greater than or equal to 3 functional systems affected at onset or after 5 years, incomplete first remission, length of the first re mission less than or equal to 1 year, >5 attacks in the first 10 years, sec ondary or primary-progressive disease, time to reach secondary progression over 5 years and time to reach EDSS 6 over 7 years. The multivariate model showed that in patients with relapsing-remitting disease 5 years after onse t, pyramidal involvement at onset and shorter time to reach EDSS 6 predicte d poor outcome, while after 10 years, higher age at onset and incomplete fi rst remission indicated poor prognosis. Ten years after onset, the predicto rs of poor outcome in the secondary-progressive group were shorter time to reach EDSS 6 or secondary progression and higher EDSS, while in the primary -progressive group those variables were spasticity or higher number of func tional systems affected at onset and higher EDSS after 5 and 10 years.