A prospective study on the prognosis of multiple sclerosis.

Two hundred and twenty-four patients at their first diagnosis of multiple sclerosis (MS) were prospectively followed for a mean period of 9.78 years. We considered as endpoints the time to reach non-reversible disability levels corresponding to EDSS scores of 4.0 and 6.0, and the beginning of a secondary progressive phase in the relapsing-remitting subgroup of patients. An initially progressive course and higher basal EDSS scores proved to be the best predictors of unfavorable prognosis. A greater number of functional systems involved at onset as well as higher residual deficits in pyramidal, visual, sphincteric and cerebellar systems were other factors predictive of a poor outcome, whereas sensory system involvement turned out to be favorable. A longer first inter-attack interval was associated with a better prognosis. However, overall number of relapses in the first two years of the disease was of no prognostic value. The presence of oligoclonal banding in the cerebrospinal fluid and a cerebral MRI exam strongly suggestive or suggestive of MS in the early phases of the disease were associated with a higher probability of a worse outcome.