Universität zu Köln

Ellenberger, David, Flachenecker, Peter, Haas, Judith, Hellwig, Kerstin, Paul, Friedemann, Stahmann, Alexander, Warnke, Clemens, Zettl, Uwe K. and Rommer, Paulus S. (2020). Is benign MS really benign? What a meaningful classification beyond the EDSS must take into consideration. Mult. Scler. Relat. Disord., 46. OXFORD: ELSEVIER SCI LTD. ISSN 2211-0356

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Abstract

Background: Multiple sclerosis (MS) is a neuroinflammatory and neurodegenerative disease with an unpredictable course that has a broad clinical spectrum and progresses over time. If a person with MS (PwMS) shows overall mild to moderate disability even after a long duration of disease, the term benign MS (BMS) is used. However, there is currently no generally accepted definition of BMS. Most definitions are based on EDSS in connection with disease duration, i.e. EDSS <= 3.0 after 15 years' disease duration. The question arises whether focusing on EDSS alone is adequate for classifying the disease course taking into account that 'hidden' or 'soft' symptoms are not sufficiently covered by this instrument. The aims of the study are to assess the prevalence of BMS in one of the largest patient cohorts, to describe the prevalence of patients without disabilities and to assess the further disability progression of these patients over another 15 years. Methods: Based on data exported from the German MS Registry, PwMS with a disease duration of 15 years or more were included in the analyses. PwMS were divided into BMS (EDSS <= 3.0) or non-benign (NBMS, EDSS 3.0). Results: Out of 31,824 PwMS included in the German MS Register, we identified 10,874 patients with a disease duration >= 15 years of whom 4,511 (42%) showed an EDSS <= 3.0 fulfilling the criterion of benign MS. In the subgroup with EDSS measured exactly at 15 years' disease duration, the proportion was 54%. This proportion decreased continuously with increasing disease duration and fell to 30% after 30 years. Female sex (hazard ratio [HR]: 0.84) was associated with BMS, while a progressive (HR: 2.09) and late disease onset (HR: 1.29) were associated with NBMS (p<0.001). With a more rigorous definition of BMS (EDSS <= 1.0, absence of disability, and active employment), only 580 (13%) of the initial BMS remained 'benign'. Conclusion: Our data propose an alternative definition (EDSS <= 1.0, absence from any disability, and the ability to work after 15 years of disease duration) which might truly reflect BMS.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Ellenberger, David UNSPECIFIED UNSPECIFIED UNSPECIFIED Flachenecker, Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Haas, Judith UNSPECIFIED UNSPECIFIED UNSPECIFIED Hellwig, Kerstin UNSPECIFIED UNSPECIFIED UNSPECIFIED Paul, Friedemann UNSPECIFIED UNSPECIFIED UNSPECIFIED Stahmann, Alexander UNSPECIFIED UNSPECIFIED UNSPECIFIED Warnke, Clemens UNSPECIFIED UNSPECIFIED UNSPECIFIED Zettl, Uwe K. UNSPECIFIED UNSPECIFIED UNSPECIFIED Rommer, Paulus S. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-312519
DOI:	10.1016/j.msard.2020.102485
Journal or Publication Title:	Mult. Scler. Relat. Disord.
Volume:	46
Date:	2020
Publisher:	ELSEVIER SCI LTD
Place of Publication:	OXFORD
ISSN:	2211-0356
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language MULTIPLE-SCLEROSIS; NATURAL-HISTORY; FATIGUE; IMPAIRMENT; DISABILITY Multiple languages Clinical Neurology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/31251