Certain findings can help identify those patients with multiple sclerosis who will have a more favorable or unfavorable course. These findings can help identify those patients who may require more aggressive management or who may be candidates for novel therapies.
Parameters:
(1) age of the patient at onset
(2) initial presentation
(3) attack frequency per year
(4) disability at 5 years from onset (as determined by Kurtzke Disability Status Scale, or DSS)
|
Parameter |
Finding |
Favorable |
Unfavorable |
|
age at onset |
< 40 years |
1 |
0 |
|
|
>= 40 years |
0 |
1 |
|
initial presentation |
optic neuritis |
1 |
0 |
|
|
sensory symptoms |
1 |
0 |
|
|
progressive weakness |
0 |
1 |
|
|
cerebellar signs |
0 |
1 |
|
attack frequency per year |
0 or 1 |
1 |
0 |
|
|
2 or more |
0 |
1 |
|
disability at 5 years |
none or minimal |
1 |
0 |
|
|
moderate or severe |
0 |
1 |
where:
• Moderate disability is indicated by a DSS level 3.
• In the study of Weinshenker et al patients with progressive disease from onset with superimposed attacks had an unfavorable course.
number of favorable factors =
= SUM(points for favorable findings)
number of unfavorable factors =
= SUM(points for unfavorable findings)
Specialty: Neurology, Immunology/Rheumatology
ICD-10: ,
