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.