Predictors of Disability and Disease Progression among a Sample of Multiple Sclerosis Patients: an Egyptian Study

Background/Objective(s) Diagnosing secondary progressive multiple sclerosis (SPMS) requires careful examination of the gradual decline that occurs following an initial relapsing-remitting multiple sclerosis (RRMS) course. Unfortunately, a lack of definitive criteria for determining when RRMS transitions to SPMS poses a challenge to accurately study the differences between the two stages of the disease. Material(s) and Method(s) This retrospective hospital-based cohort study included 3123 patients diagnosed with multiple sclerosis (MS) according to the revised 2017 McDonald criteria and recruited from the registry of the MS unit at Ain Shams University over 2 years. Demographic, clinical, and magnetic resonance imaging (MRI) data were collected. The diagnosis of SPMS was based on a 1-point increase in the Expanded Disability Status Scale (EDSS) score if the score was 5.5 or less, and a 0.5-point increase if the score was at least 6.0, without any relapses. In addition, SPMS confirmed diagnosis required an EDSS score of at least 4, a pyramidal functional (FS) score of at least 2, and confirmed progression lasting for at least 3 months. Result(s) During the study period; 213 (6.82%) patients were found to be SPMS. Females represented 132 (67.35%), the mean age at the onset of the disease was 26.75 ± 8.4 (SD) years. While the mean duration of illness was 16.11 ± 7.49 (SD) years. The mean EDSS of the patients was 6.056 ± 1.36 and the mean number of relapses in the first 2 years was 2.95 ± 1.67 (SD) years. The number and types of MRI lesions both at baseline and last available one (T2 and T1 black holes) in the different anatomical locations (periventricular, juxtacortical, infratentorial, and spinal) were correlated with the clinical and demographic data, as well as with the EDSS score of the patients. The presence of periventricular and spinal cord lesions and brain atrophy at baseline were significantly correlated to high EDSS scores (p< 0.001, p= 0.038 and p = 0.002, respectively). In additon, the number of T2 lesions > 10 was significantly correlated to the progression of the EDSS scores (p=0.007). Conclusion(s) This study showed that the predictors of disability and disease progression in Egyptian MS patients include male gender, higher age at the onset of disease, increased number of disease relapses in the first two years of illness, the presence of spinal cord lesions, brain atrophy, and more than ten T2 lesion at the baseline MRI. Diagnosing secondary progressive multiple sclerosis (SPMS) requires careful examination of the gradual decline that occurs following an initial relapsing-remitting multiple sclerosis (RRMS) course. Unfortunately, a lack of definitive criteria for determining when RRMS transitions to SPMS poses a challenge to accurately study the differences between the two stages of the disease. This retrospective hospital-based cohort study included 3123 patients diagnosed with multiple sclerosis (MS) according to the revised 2017 McDonald criteria and recruited from the registry of the MS unit at Ain Shams University over 2 years. Demographic, clinical, and magnetic resonance imaging (MRI) data were collected. The diagnosis of SPMS was based on a 1-point increase in the Expanded Disability Status Scale (EDSS) score if the score was 5.5 or less, and a 0.5-point increase if the score was at least 6.0, without any relapses. In addition, SPMS confirmed diagnosis required an EDSS score of at least 4, a pyramidal functional (FS) score of at least 2, and confirmed progression lasting for at least 3 months. During the study period; 213 (6.82%) patients were found to be SPMS. Females represented 132 (67.35%), the mean age at the onset of the disease was 26.75 ± 8.4 (SD) years. While the mean duration of illness was 16.11 ± 7.49 (SD) years. The mean EDSS of the patients was 6.056 ± 1.36 and the mean number of relapses in the first 2 years was 2.95 ± 1.67 (SD) years. The number and types of MRI lesions both at baseline and last available one (T2 and T1 black holes) in the different anatomical locations (periventricular, juxtacortical, infratentorial, and spinal) were correlated with the clinical and demographic data, as well as with the EDSS score of the patients. The presence of periventricular and spinal cord lesions and brain atrophy at baseline were significantly correlated to high EDSS scores (p< 0.001, p= 0.038 and p = 0.002, respectively). In additon, the number of T2 lesions > 10 was significantly correlated to the progression of the EDSS scores (p=0.007). This study showed that the predictors of disability and disease progression in Egyptian MS patients include male gender, higher age at the onset of disease, increased number of disease relapses in the first two years of illness, the presence of spinal cord lesions, brain atrophy, and more than ten T2 lesion at the baseline MRI.