title: The natural history of multiple sclerosis: a geographically based study. 5. The clinical features and natural history of primary progressive multiple sclerosis.
abstract: We report a natural history study of 216 patients with primary progressive (PP)- multiple sclerosis defined by at least 1 year of exacerbation-free progression at onset. This represents 19.8% of a largely population-based patient cohort having a mean longitudinal follow-up of 23 years. This subgroup of PP-multiple sclerosis patients had a mean age of onset of 38.5 years, with females predominating by a ratio of 1.3:1.0. The rate of deterioration from disease onset was substantially more rapid than for relapsing-remitting multiple sclerosis, with a median time to disability status score (DSS) 6 and DSS 8 of 8 and 18 years, respectively. Forty-nine percent of patients were followed through to death. Examination of the early disease course revealed two groups with adverse prognostic profiles. Firstly, a shorter time to reach DSS 3 from onset of PP-multiple sclerosis significantly adversely influenced time to DSS 8. Second, involvement of three or more neurological systems at onset resulted in a median time to DSS 10 of 13.5 years in contrast to PP-multiple sclerosis patients with one system involved at onset where median time to death from multiple sclerosis was 33.2 years. However, age, gender and type of neurological system involved at onset appeared to have little influence on prognosis. Life expectancy, cause of mortality and familial history profile were similar in PP-multiple sclerosis and non-PP-multiple sclerosis (all other multiple sclerosis patients from the total population). From clinical onset, rate of progression was faster in the PP-multiple sclerosis group than in the secondary progressive (SP)-multiple sclerosis group. When the rates of progression from onset of the progressive phase to DSS 6, 8 and 10 were compared, SP-multiple sclerosis had a more rapid progressive phase. A substantial minority (28%) of the PP-multiple sclerosis cohort had a distinct relapse even decades after onset of progressive deterioration. These studies establish natural history outcomes for the subgroup of multiple sclerosis patients with primary progressive disease.
authors.affiliation: Department of Clinical Neurological Sciences, University of Western Ontario, London, Canada.
authors.forename: D A
authors.initials: DA
authors.lastname: Cottrell
authors.forename: M
authors.initials: M
authors.lastname: Kremenchutzky
authors.forename: G P
authors.initials: GP
authors.lastname: Rice
authors.forename: W J
authors.initials: WJ
authors.lastname: Koopman
authors.forename: W
authors.initials: W
authors.lastname: Hader
authors.forename: J
authors.initials: J
authors.lastname: Baskerville
authors.forename: G C
authors.initials: GC
authors.lastname: Ebers
mesh_terms: D000328:Adult; D017677:Age Distribution; D017668:Age of Onset; D000554:Ambulatory Care Facilities; D015331:Cohort Studies; D004185:Disability Evaluation; D018450:Disease Progression; D005192:Family Health; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009103:Multiple Sclerosis / Q000401:mortality* / Q000534:rehabilitation*; D009864:Ontario; D011379:Prognosis; D017678:Sex Distribution; D016019:Survival Analysis; D016896:Treatment Outcome