Predicting clinical progression in multiple sclerosis after six and twelve years

OBJECTIVES: To predict disability and cognition in multiple sclerosis (MS) after 6 and 12 years, using early clinical and imaging measures. METHODS: In total 115 MS patients were selected and followed-up after 2 and 6 years, 79 patients also after 12 years. Disability was measured using the expanded disability status scale (EDSS); cognition only at follow-up using neuropsychological testing. Predictors-of-interest included EDSS, baseline brain and lesion volumes and their changes over 2 years, baseline age, clinical phenotype, sex and educational level. RESULTS: Higher 6-year EDSS was predicted by early EDSS- and whole-brain volume changes and baseline diagnosis of primary progressive MS (PPMS) (adjusted R2 =0.56). Predictors for 12-year EDSS included higher EDSS changes and higher T1-hypointense lesion volumes (adjusted R2 =0.38). Year 6 cognition was predicted by PPMS phenotype, lower educational level, male sex, and early whole-brain atrophy (adjusted R2 =0.26); year 12 predictors included male sex, lower educational level and higher baseline T1-hypointense lesion volumes (adjusted R2 =0.14). CONCLUSIONS: Patients with early signs of neurodegeneration and a progressive disease onset are more prone to develop both disability progression and cognitive dysfunction. Male sex and lower educational level only affected cognitive dysfunction, which remains difficult to predict and likely needs more advanced imaging measures. This article is protected by copyright. All rights reserved.