title: Benign multiple sclerosis: a new definition of this entity is needed.
abstract: BACKGROUND
  To study a cohort of benign multiple sclerosis (BMS) patients beyond physical disability, including the evaluation of cognitive and social function, as well as fatigue, pain and MRI studies.
  
  
  METHODS
  A cohort of 342 patients was prospectively followed for 10.9 ± 0.71 years. Forty-three patients (12.5%) met the BMS diagnosis criteria [Expanded Disability Status Scale (EDSS) < 3 after at least 10 years' disease duration], undergoing full neurological examination every 6 months. Neuropsychological status, pain, fatigue, social functioning and work-related disability, as well as brain MRIs, were assessed yearly.
  
  
  RESULTS
  By the end of follow-up, 20 of 43 BMS patients (47%) had suffered cognitive impairment and 23 (53.3%) referred depression. Furthermore, 21 (48.8%) reported significant changes in pain intensity, with fatigue and environmental severity scores significantly increasing over time in 33-35% of patients. Finally, 32 BMS patients (74%) showed significant increase in the number of new or enlarging T2 lesions, gadolinium-enhanced lesions, and persistent black holes, without changes in EDSS. Thirty-five of 43 patients (81%) fulfilling the BMS diagnostic criteria showed significant worsening of cognitive function, fatigue, pain or depression during the 10-year follow-up.
  
  
  CONCLUSIONS
  Currently accepted criteria for BMS diagnosis may cause overestimation of true prevalence, underscoring the need for routine monitoring of non-motor symptoms and imaging studies, to help physicians improve diagnostic accuracy as well as therapeutic decision-making in this subgroup of MS patients.
authors.affiliation: Department of Neurology, Institute for Neurological Research Raúl Carrea, FLENI, Buenos Aires, Argentina. jcorreale@fleni.org.ar
authors.forename: Jorge
authors.initials: J
authors.lastname: Correale
authors.forename: Isabel
authors.initials: I
authors.lastname: Peirano
authors.forename: Lucas
authors.initials: L
authors.lastname: Romano
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D004185:Disability Evaluation; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D009103:Multiple Sclerosis / Q000145:classification* / Q000453:epidemiology* / Q000473:pathology; D009483:Neuropsychological Tests; D010146:Pain / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index