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Multiple Sclerosis—From Probable to Definite Diagnosis
A 7-Year Prospective Study
Anat Achiron, MD, PhD;
Yoram Barak, MD
Arch Neurol. 2000;57:974-979.
Objectives To investigate the rate of progression from probable to clinically definite multiple sclerosis (MS) and to define patients who had rapidly (within 1 year) progressed to a definite diagnosis.
Design A 7-year prospective study.
Patients A group of 163 patients experiencing their first episode of neurologic symptoms suggestive of MS. All patients had brain magnetic resonance imaging that demonstrated at least 3 demyelinating lesions at onset.
Results Within the follow-up period (mean, 42 months; range, 13-84 months), 136 patients (83.4%) had an additional relapse and were thus defined as having clinically definite MS, whereas 27 patients (16.6%) were defined as having clinically probable MS. Most of the 136 patients with clinically definite MS (57.6%, 94 patients) experienced the additional relapse within 1 year. Demographic and clinical parameters at presentation were analyzed to identify variables predictive of rapid progression (within 1 year) to clinical definite MS. Motor involvement at onset was the only clinical parameter associated with rapid progression to a definite diagnosis. Survival curves demonstrated that polysymptomatic involvement and higher Extended Disability Status Scale score at presentation correlated with rapid progression to definite diagnosis.
Conclusion Most patients with a diagnosis of probable MS and positive brain magnetic resonance imaging will progress rapidly to clinically definite MS.
From the Multiple Sclerosis Center, The Chaim Sheba Medical Center, Tel Hashomer (Dr Achiron), and Abarbanel Mental Health Center, Bat Yam (Dr Barak), Israel.
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