Tuesday, February 13, 2007

Mild cases of MS will get worse, study finds

Findings are a reality check for patients and doctors, neurologist says

Pamela Fayerman, Vancouver Sun
Published: Tuesday, February 13, 2007

A substantial number of benign or mild cases of multiple sclerosis eventually progress to severe forms, according to a study by University of B.C. researchers published today in the journal Neurology.

The study's results go against conventional wisdom that people with mild forms of the disease won't become severely affected.

The authors say that until this study, patients with 10 years of benign disease have been "reassured that disabling symptoms or loss of function will unlikely occur to the same extent as in other patients with MS."

Dr. Virginia Devonshire, a neurologist who heads the UBC MS clinic and co-author of the study, said it is a reality check for patients and doctors.

The UBC study of 169 patients found nearly half went on to develop more severe disease 20 years after they were first given a benign disease diagnosis. Of those, 21 per cent became severely affected with restricted mobility, meaning they required a cane for walking and balance.

Fifty-two per cent remained as benign cases, which means their functions and mobility weren't seriously affected by the disease.

Devonshire said she doesn't want to discourage MS patients with a doom-and-gloom scenario.

"I wouldn't want this described as bad news, but we have to put it into perspective that you can't necessarily predict the course of MS," said Devonshire, who co-authored the study with Dr. Ana-Luiza Sayao and Helen Tremlett.

"Just because a patient does well in the first 10 years [after diagnosis] doesn't necessarily mean they will continue to do well because 10 years after disease onset may still be too early to predict a benign disease course," she said.

"Some of the patients in our study would have been told they had benign disease but we found that only about half of patients continued to have benign disease so as health providers, we do need to be cautious and tell patients that we can't predict the course of MS. It is a complex, very individual disease."

The patients in the study had first presented to the clinic 20 years ago. To understand the current state of their disease, researchers reviewed their charts or did clinical reassessments or asked patients to complete a questionnaire by telephone or by mail. Only three of the 169 patients had died in the past 20 years, from cervical cancer, suicide and stroke complications.

Devonshire noted other recent UBC research has a more positive message for those with MS: While they used to be told they would probably need to use canes 15 years into their disease, the latest local research shows "overall, it takes 27 years from onset of symptoms to the time that someone has disability enough to require the constant use of a cane. "

MS is an autoimmune disease with symptoms that may include muscle weakness, pain, numbness, tingling, vision loss, difficulties walking, poor balance and coordination. It affects far more women than men and the mean age at onset in the current study was 29.8 years of age.

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