Multiple sclerosis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.
Overview
Multiple sclerosis usually start between age of fifteen to forty years, rarely before age fifteen or after age sixty with symptoms such as optic neuritis, diplopia, sensory or motor loss, vertigo and balance problems. It may be classified into four groups according to clinical course of the disease including relapsing-remitting, secondary-progressive, primary-progressive, and progressive-relapsing. Complications that can develop as a result of multiple sclerosis are: medication complication, Fatigue, mood problems, Spasticity, Bowel and bladder dysfunction, Cognitive impairment, Heat sensitivity., Incoordination, Pain, Sexual dysfunction, Sleep disorders, vertigo, visual loss. there are some factors associated with a particularly poor prognosis among patients with multiple sclerosis such as: Relapsing versus progressive disease, early symptoms, Demographics, Sex, Smoking.
Natural History, Complications, and Prognosis
Natural History
- Multiple sclerosis usually start between age of fifteen to forty years, rarely before age fifteen or after age sixty with symptoms such as optic neuritis, diplopia, sensory or motor loss, vertigo, and balance problems. In young adult eye and sensory problems are prominent while in older patients we see motor problems more often.[1]
- The natural history of the disease is either relapsing or progressive.
- Relapsing-remitting multiple sclerosis is defined by acute attacks of neurological dysfunction followed by full or partial recovery. Patient clinical symptoms are stable between the attacks.
- It can switch to secondary progressive disease when the neurological symptoms progressively worsen between the attacks.
- There is also primary progressive type, which is defined by continuously worsening of neurological dysfunction with no distinct attacks and remissions.
- Progressive relapsing type is a mixture of relapsing and progression and is defined by progression of disease from the beginning with acute attack episodes.[2]
- The most common symptoms in all of the MS patients are fatigue, mood problems, spasticity, bowel and bladder dysfunction, cognitive impairment, eye movement abnormalities, heat sensitivity, incoordination , pain, sexual dysfunction, sleep disorders, vertigo, and visual loss.[3][4][5][6][7][8][9][10][11][12][13][14][15]
Complications
Complications that can develop as a result of mutiple sclerosis include:
- Medication complications: Insufficient blood supply to the bone can cause avascular osteonecrosis. After trauma, corticosteroid treatment is the most common cause of AVN.[16][17]
- Fatigue: Fatigue is seen in almost 80% of MS patients. They commonly feel exhausted and out of energy. We can see fatigue exacerbation before acute attacks in MS and for a while after that.[18]
- Mood problems: Psychiatric disorders especially depression is common and can be seen in almost 50% of MS patients.[5] Some studies show higher risk of suicide in MS patient.[19][20]
- Spasticity: Damage to the upper motor neurons and decrease inhibition of lower motor neurons in MS can increase muscle tone and rigidity in 75% of MS patients.[6]
- Bowel and bladder dysfunction: Bowel and bladder dysfunction is common in MS patients and occurs in more than 50% of cases.[7] bladder dysfunction can be the result of Detrusor overactivity, Detrusor sphincter dyssynergia, Inefficient bladder contractility and Abnormal sensation and bladder hypoactivity.[21] the most common bowel problems include Constipation, poor defecation and incontinence.[22]
- Cognitive impairment: Cognitive disorders is common in MS patients and can even present at early stages of disease. These disorders are in attention, short term memory, and information processing. Relapsing-remitting type of MS seems to have a lower cognitive problems.[8][23][24][25]
- Heat sensitivity: Patients with MS disease are more sensitive to heat. A slight increase in body temperature of these patients will lead to worsening of their signs and symptoms.[10]
- Incoordination: Involvement of cerebellar tracts can cause problems in Gait and balance, poor coordinated actions, and slurred speech. Intention tremor is present in most of these patients.[11]
- Pain: Pain is a very common symptom in MS. Patients can be either from neurogenic source leading to burning or ice-cold dysesthesias or from long immobilization and spasm.[12][26]
- Sexual dysfunction: Sexual dysfunction can be due to involvement of motor and sensory pathways or from psychological problems. Either way, it’s a very common symptom. In women, we can see reduced libido and orgasm, dyspareunia and decrease vaginal sensation. Presentations of sexual dysfunction in men are decreased libido and premature ejaculation, erectile dysfunction and decreased penile sensation.[13][27]
- Sleep disorders: Many patients with multiple sclerosis suffer from sleep disorders and daytime somnolence. This can be the result of so many conditions including restless leg syndrome, nocturia, pain, and medication side effects. Having more cervical lesions lead to experiencing restless leg syndrome more often.[14][28][29]
- Vertigo: Benign positional paroxysmal vertigo is the most common cause of vertigo in an MS patient. In the course of the disease about 30-50% of patients experience this symptom.[15]
- Visual loss: Optic neuritis is the most common eye involvement and presents as an acute unilateral eye pain, followed by some degree of vision loss.[3]
Prognosis
There are some factors associated with a particularly poor prognosis among patients with multiple sclerosis. However, we can’t surly say what is the prognosis of MS patients.[30]
- Relapsing versus progressive disease: Progressive form of MS seems to have a worse prognosis in comparison to relapsing remitting form of MS. Disabilities start sooner in progressive form[31][32][33] but some studies showed that age of onset is more important in MS disability than the form of the disease.[34][35]
- Early symptoms: Some first manifestations of MS disease like bowel and bladder dysfunction seem to have a worse prognosis.[36]. Another study demonstrated that having so many symptoms at the onset of the disease have a worse prognosis than being monosymptom.[37]
- Demographics: Onset of MS in Black Americans is in later age and they are more susceptible of having multifocal signs and symptoms and involvement of optic nerve and spinal cord.[38]
- Lipid specific immunoglobulin level: Lipid specific immunoglobulin level in CSF can predict long term outcomes of MS disease.[40]
References
- ↑ Weinshenker BG, Bass B, Rice GP, Noseworthy J, Carriere W, Baskerville J, Ebers GC (February 1989). "The natural history of multiple sclerosis: a geographically based study. I. Clinical course and disability". Brain. 112 ( Pt 1): 133–46. PMID 2917275.
- ↑ Lublin FD, Reingold SC (April 1996). "Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis". Neurology. 46 (4): 907–11. PMID 8780061.
- ↑ 3.0 3.1 Balcer LJ (March 2006). "Clinical practice. Optic neuritis". N. Engl. J. Med. 354 (12): 1273–80. doi:10.1056/NEJMcp053247. PMID 16554529.
- ↑ Čarnická Z, Kollár B, Šiarnik P, Krížová L, Klobučníková K, Turčáni P (April 2015). "Sleep disorders in patients with multiple sclerosis". J Clin Sleep Med. 11 (5): 553–7. doi:10.5664/jcsm.4702. PMC 4410929. PMID 25700869.
- ↑ 5.0 5.1 Sadovnick AD, Remick RA, Allen J, Swartz E, Yee IM, Eisen K, Farquhar R, Hashimoto SA, Hooge J, Kastrukoff LF, Morrison W, Nelson J, Oger J, Paty DW (March 1996). "Depression and multiple sclerosis". Neurology. 46 (3): 628–32. PMID 8618657.
- ↑ 6.0 6.1 Boissy AR, Cohen JA (September 2007). "Multiple sclerosis symptom management". Expert Rev Neurother. 7 (9): 1213–22. doi:10.1586/14737175.7.9.1213. PMID 17868019.
- ↑ 7.0 7.1 DasGupta R, Fowler CJ (2003). "Bladder, bowel and sexual dysfunction in multiple sclerosis: management strategies". Drugs. 63 (2): 153–66. PMID 12515563.
- ↑ 8.0 8.1 Achiron A, Barak Y (April 2003). "Cognitive impairment in probable multiple sclerosis". J. Neurol. Neurosurg. Psychiatry. 74 (4): 443–6. PMC 1738365. PMID 12640060.
- ↑ Frohman EM, Frohman TC, Zee DS, McColl R, Galetta S (February 2005). "The neuro-ophthalmology of multiple sclerosis". Lancet Neurol. 4 (2): 111–21. doi:10.1016/S1474-4422(05)00992-0. PMID 15664543.
- ↑ 10.0 10.1 Selhorst JB, Saul RF (June 1995). "Uhthoff and his symptom". J Neuroophthalmol. 15 (2): 63–9. PMID 7550931.
- ↑ 11.0 11.1 Rinker JR, Salter AR, Walker H, Amara A, Meador W, Cutter GR (January 2015). "Prevalence and characteristics of tremor in the NARCOMS multiple sclerosis registry: a cross-sectional survey". BMJ Open. 5 (1): e006714. doi:10.1136/bmjopen-2014-006714. PMC 4289717. PMID 25573524.
- ↑ 12.0 12.1 Drulovic J, Basic-Kes V, Grgic S, Vojinovic S, Dincic E, Toncev G, Kezic MG, Kisic-Tepavcevic D, Dujmovic I, Mesaros S, Miletic-Drakulic S, Pekmezovic T (August 2015). "The Prevalence of Pain in Adults with Multiple Sclerosis: A Multicenter Cross-Sectional Survey". Pain Med. 16 (8): 1597–602. doi:10.1111/pme.12731. PMID 26087108.
- ↑ 13.0 13.1 Lew-Starowicz M, Gianotten WL (2015). "Sexual dysfunction in patients with multiple sclerosis". Handb Clin Neurol. 130: 357–70. doi:10.1016/B978-0-444-63247-0.00020-1. PMID 26003254.
- ↑ 14.0 14.1 Manconi M, Rocca MA, Ferini-Strambi L, Tortorella P, Agosta F, Comi G, Filippi M (January 2008). "Restless legs syndrome is a common finding in multiple sclerosis and correlates with cervical cord damage". Mult. Scler. 14 (1): 86–93. doi:10.1177/1352458507080734. PMID 17942519.
- ↑ 15.0 15.1 Frohman EM, Zhang H, Dewey RB, Hawker KS, Racke MK, Frohman TC (November 2000). "Vertigo in MS: utility of positional and particle repositioning maneuvers". Neurology. 55 (10): 1566–9. PMID 11094117.
- ↑ Yamamoto T, Irisa T, Sugioka Y, Sueishi K (November 1997). "Effects of pulse methylprednisolone on bone and marrow tissues: corticosteroid-induced osteonecrosis in rabbits". Arthritis Rheum. 40 (11): 2055–64. doi:10.1002/1529-0131(199711)40:11<2055::AID-ART19>3.0.CO;2-E. PMID 9365096.
- ↑ Assouline-Dayan Y, Chang C, Greenspan A, Shoenfeld Y, Gershwin ME (October 2002). "Pathogenesis and natural history of osteonecrosis". Semin. Arthritis Rheum. 32 (2): 94–124. PMID 12430099.
- ↑ Krupp L (August 2006). "Fatigue is intrinsic to multiple sclerosis (MS) and is the most commonly reported symptom of the disease". Mult. Scler. 12 (4): 367–8. doi:10.1191/135248506ms1373ed. PMID 16900749.
- ↑ Sadovnick AD, Eisen K, Ebers GC, Paty DW (August 1991). "Cause of death in patients attending multiple sclerosis clinics". Neurology. 41 (8): 1193–6. PMID 1866003.
- ↑ Stenager EN, Stenager E (December 1992). "Suicide and patients with neurologic diseases. Methodologic problems". Arch. Neurol. 49 (12): 1296–303. PMID 1449409.
- ↑ Wintner A, Kim MM, Bechis SK, Kreydin EI (April 2016). "Voiding Dysfunction in Multiple Sclerosis". Semin Neurol. 36 (2): 219–20. doi:10.1055/s-0036-1582255. PMID 27116728.
- ↑ Hennessey A, Robertson NP, Swingler R, Compston DA (November 1999). "Urinary, faecal and sexual dysfunction in patients with multiple sclerosis". J. Neurol. 246 (11): 1027–32. PMID 10631634.
- ↑ Deloire MS, Salort E, Bonnet M, Arimone Y, Boudineau M, Amieva H, Barroso B, Ouallet JC, Pachai C, Galliaud E, Petry KG, Dousset V, Fabrigoule C, Brochet B (April 2005). "Cognitive impairment as marker of diffuse brain abnormalities in early relapsing remitting multiple sclerosis". J. Neurol. Neurosurg. Psychiatry. 76 (4): 519–26. doi:10.1136/jnnp.2004.045872. PMC 1739602. PMID 15774439.
- ↑ Rao SM, Leo GJ, Bernardin L, Unverzagt F (May 1991). "Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction". Neurology. 41 (5): 685–91. PMID 2027484.
- ↑ Huijbregts SC, Kalkers NF, de Sonneville LM, de Groot V, Reuling IE, Polman CH (July 2004). "Differences in cognitive impairment of relapsing remitting, secondary, and primary progressive MS". Neurology. 63 (2): 335–9. PMID 15277630.
- ↑ Foley PL, Vesterinen HM, Laird BJ, Sena ES, Colvin LA, Chandran S, MacLeod MR, Fallon MT (May 2013). "Prevalence and natural history of pain in adults with multiple sclerosis: systematic review and meta-analysis". Pain. 154 (5): 632–42. doi:10.1016/j.pain.2012.12.002. PMID 23318126.
- ↑ Zivadinov R, Zorzon M, Bosco A, Bragadin LM, Moretti R, Bonfigli L, Iona LG, Cazzato G (December 1999). "Sexual dysfunction in multiple sclerosis: II. Correlation analysis". Mult. Scler. 5 (6): 428–31. doi:10.1177/135245859900500i610. PMID 10618700.
- ↑ Amarenco G, Kerdraon J, Denys P (December 1995). "[Bladder and sphincter disorders in multiple sclerosis. Clinical, urodynamic and neurophysiological study of 225 cases]". Rev. Neurol. (Paris) (in French). 151 (12): 722–30. PMID 8787103.
- ↑ Schürks M, Bussfeld P (April 2013). "Multiple sclerosis and restless legs syndrome: a systematic review and meta-analysis". Eur. J. Neurol. 20 (4): 605–15. doi:10.1111/j.1468-1331.2012.03873.x. PMID 23078359.
- ↑ Swanton J, Fernando K, Miller D (2014). "Early prognosis of multiple sclerosis". Handb Clin Neurol. 122: 371–91. doi:10.1016/B978-0-444-52001-2.00015-7. PMID 24507526.
- ↑ 31.0 31.1 Weinshenker BG (1994). "Natural history of multiple sclerosis". Ann. Neurol. 36 Suppl: S6–11. PMID 8017890.
- ↑ Confavreux C, Vukusic S, Moreau T, Adeleine P (November 2000). "Relapses and progression of disability in multiple sclerosis". N. Engl. J. Med. 343 (20): 1430–8. doi:10.1056/NEJM200011163432001. PMID 11078767.
- ↑ Tremlett H, Paty D, Devonshire V (January 2006). "Disability progression in multiple sclerosis is slower than previously reported". Neurology. 66 (2): 172–7. doi:10.1212/01.wnl.0000194259.90286.fe. PMID 16434648.
- ↑ Confavreux C, Vukusic S (March 2006). "Age at disability milestones in multiple sclerosis". Brain. 129 (Pt 3): 595–605. doi:10.1093/brain/awh714. PMID 16415309.
- ↑ Confavreux C, Vukusic S (March 2006). "Natural history of multiple sclerosis: a unifying concept". Brain. 129 (Pt 3): 606–16. doi:10.1093/brain/awl007. PMID 16415308.
- ↑ Langer-Gould A, Popat RA, Huang SM, Cobb K, Fontoura P, Gould MK, Nelson LM (December 2006). "Clinical and demographic predictors of long-term disability in patients with relapsing-remitting multiple sclerosis: a systematic review". Arch. Neurol. 63 (12): 1686–91. doi:10.1001/archneur.63.12.1686. PMID 17172607.
- ↑ Kremenchutzky M, Rice GP, Baskerville J, Wingerchuk DM, Ebers GC (March 2006). "The natural history of multiple sclerosis: a geographically based study 9: observations on the progressive phase of the disease". Brain. 129 (Pt 3): 584–94. doi:10.1093/brain/awh721. PMID 16401620.
- ↑ Cree BA, Khan O, Bourdette D, Goodin DS, Cohen JA, Marrie RA, Glidden D, Weinstock-Guttman B, Reich D, Patterson N, Haines JL, Pericak-Vance M, DeLoa C, Oksenberg JR, Hauser SL (December 2004). "Clinical characteristics of African Americans vs Caucasian Americans with multiple sclerosis". Neurology. 63 (11): 2039–45. PMID 15596747.
- ↑ Roudbari SA, Ansar MM, Yousefzad A (July 2013). "Smoking as a risk factor for development of Secondary Progressive Multiple Sclerosis: A study in IRAN, Guilan". J. Neurol. Sci. 330 (1–2): 52–5. doi:10.1016/j.jns.2013.04.003. PMID 23628463.
- ↑ Thangarajh M, Gomez-Rial J, Hedström AK, Hillert J, Alvarez-Cermeño JC, Masterman T, Villar LM (November 2008). "Lipid-specific immunoglobulin M in CSF predicts adverse long-term outcome in multiple sclerosis". Mult. Scler. 14 (9): 1208–13. doi:10.1177/1352458508095729. PMID 18755821.