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MS research update - More relapses in MS does not predict earlier progression or mobility difficulties - 17 April 2013


This research followed 730 people with relapsing remitting MS in Canada for 28 years. It found that the number of relapses that someone experienced early in their MS, did not predict when or whether they moved to having secondary progressive MS or reached a particular level of disability.


When someone has been diagnosed with MS, one of the commonly asked questions is "How will my MS develop?" Unfortunately, due to the varied and unpredictable nature of MS it has been impossible to answer with any certainty.

This research hoped to resolve this question by following a large number of people over nearly 30 years to see if people who experienced a higher relapse rate early in their disease went on to have secondary progressive MS or mobility difficulties earlier.

How this study was carried out

730 people with relapsing remitting MS in Canada were followed for 28 years. The researchers looked at the whole group but also at sub-groups divided according to the number of relapses they experienced in the first two years of their MS. The time that it took for someone's MS to change from relapsing remitting MS (RRMS) to secondary progressive MS (SPMS) was noted. They also recorded the time it took before someone had to use a walking stick (DSS score of 6) or became bedbound (DSS score of 8). DSS (Disability Status Scale) is an earlier form of the more common EDSS score.

What was found

The researchers found that, among the 158 people with frequent early relapses (at least three relapses in the first two years), the outcomes were variable. About two thirds (65%) rapidly made the transition to SPMS (on average after five years) then to a DSS score of 6 (on average after seven years) and then a DSS score of 8 (after an average of 17 years). However, one third of this sub-group did not have secondary progressive MS at the end of the 28 year study but still had relapsing remitting MS.

Looking at all those who had secondary progressive MS by the end of the 28 year study, those individuals who took longer to reach the transition from RRMS to SPMS also had a lower probability of reaching an EDSS of 6 and an EDSS score of 8.

The length of time that someone's MS was relapsing remitting did not influence the time it took for them to go from the SPMS transition to a particular DSS score.

What does it mean?

The researchers concluded that the number of early relapses does not predict the time it will take for someone's MS to change from RRMS to SPMS as they observed the whole range of possibilities in their population. This means that it is still almost impossible to predict the disease course of someone's MS and, despite this long term study, we still cannot answer the question "How will my MS develop?"

Scalfari A, Neuhaus A, Daumer M, et al.
Early relapses, onset of progression, and late outcome in multiple sclerosis.
JAMA Neurol. 2013 Feb;70(2):214-22.

More about prognosis and types of MS

Prognosis is the term used to describe the likely course of a disease for a particular person. Even in the easiest of circumstances, it is a best guess – a prediction based on the clinicians' experience and on research – and can never be something exact.

In MS, giving a prognosis is particularly difficult. Everyone's MS is different and varies from day to day as well as in the longer term. You can read more about prognosis in the A to Z of MS. You can also find information on the different types of MS, relapses and treatment options.

Research by topic areas...

Symptoms and symptom management

Pakpoor J, Handel AE, Giovannoni G, et al.
Correction: Meta-Analysis of the Relationship between Multiple Sclerosis and Migraine.
PLoS One. 2013;8(4).
Read the full text of this paper

Disease modifying treatments

Jongen PJ, Sanders E, Zwanikken C, et al.
Adherence to monthly online self-assessments for short-term monitoring: a 1-year study in relapsing-remitting multiple sclerosis patients after start of disease modifying treatment.
Patient Prefer Adherence. 2013 Apr 9;7:293-300.

Chan A, Lo-Coco F.
Mitoxantrone-related acute leukemia in MS: An open or closed book?
Neurology. 2013 Apr 16;80(16):1529-33.

Arnold DL, Narayanan S, Antel S.
Neuroprotection with glatiramer acetate: evidence from the PreCISe trial.
J Neurol. 2013 Apr 16. [Epub ahead of print]

Ayers CL, Mendoza JP, Sinha S, et al.
Modulation of immune function occurs within hours of therapy initiation for multiple sclerosis.
Clin Immunol. 2013 Mar 6;147(2):105-119. doi: 10.1016/j.clim.2013.02.015. [Epub ahead of print]

Other treatments

Shaygannejad V, Janghorbani M, Vaezi A, et al.
Comparison of the effect of baclofen and transcutaneous electrical nerve stimulation for the treatment of spasticity in multiple sclerosis.
Neurol Res.2013 Apr 12. [Epub ahead of print]


Tullman MJ.
Overview of the epidemiology, diagnosis, and disease progression associated with multiple sclerosis.
Am J Manag Care. 2013 Feb;19(2 Suppl):s15-20.

Assessment tools

Learmonth YC, Dlugonski DD, Pilutti LA, et al.
The reliability, precision and clinically meaningful change of walking assessments in multiple sclerosis.
Mult Scler. 2013 Apr 15. [Epub ahead of print]

Bogosian A, Moss-Morris R, Bishop FL, et al.
Development and initial validation of the Perceptions of Parental Illness Questionnaire (PPIQ).
J Health Psychol. 2013 Apr 12. [Epub ahead of print]

Hobart J, Cano S, Baron R, et al.
Achieving valid patient-reported outcomes measurement: a lesson from fatigue in multiple sclerosis.
Mult Scler. 2013 Apr 10. [Epub ahead of print]

Causes of MS

Almohmeed YH, Avenell A, Aucott L, et al.
Systematic review and meta-analysis of the sero-epidemiological association between Epstein Barr virus and multiple sclerosis.
PLoS One. 2013 Apr 9;8(4):e61110

Valery PC, Lucas RM, Williams DB, et al.
Occupational exposure and risk of central nervous system demyelination.
Am J Epidemiol. 2013 Apr 12. [Epub ahead of print]

Frei P, Poulsen AH, Mezei G, et al.
Residential Distance to High-voltage Power Lines and Risk of Neurodegenerative Diseases: a Danish Population-based Case-Control Study.
Am J Epidemiol. 2013 Apr 9. [Epub ahead of print]

Valera P, Zavattari P, Albanese S, et al
A correlation study between multiple sclerosis and type 1 diabetes incidences and geochemical data in Europe.
Environ Geochem Health. 2013 Apr 9. [Epub ahead of print]

Paediatric MS

Tantsis EM, Prelog K, Brilot F, et al.
Risk of multiple sclerosis after a first demyelinating syndrome in an Australian Paediatric cohort: clinical,radiological features and application of the McDonald 2010 MRI criteria.
Mult Scler. 2013 Apr 11. [Epub ahead of print]

Krupp LB, Tardieu M, Amato MP, et al.
International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: revisions to the 2007 definitions.
Mult Scler. 2013 Apr 9. [Epub ahead of print]


Mathis AS.
Managed care aspects of managing multiple sclerosis.
Am J Manag Care. 2013 Feb;19(2 Suppl):s28-34.

Psychological aspects

Arnett PA, Brochet B.
How can cognitive reserve in multiple sclerosis inform clinical care?
Neurology. 2013 Apr 10. [Epub ahead of print]


Koeser L, McCrone P.
Cost-effectiveness of natalizumab in multiple sclerosis: an updated systematic review.
Expert Rev Pharmacoecon Outcomes Res. 2013 Apr;13(2):171-82.


Amato MP, Razzolini L, Goretti B, et al.
Cognitive reserve and cortical atrophy in multiple sclerosis: A longitudinal study.
Neurology. 2013 Apr 10.[Epub ahead of print]


Tullman MJ.
A review of current and emerging therapeutic strategies in multiple sclerosis.
Am J Manag Care. 2013 Feb;19(2 Suppl):s21-7.

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