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What is the risk of permanent disability from a multiple sclerosis relapse?

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Medical Update Memo
June 7, 2010


Authors report on how often patients with relapsing-remitting multiple sclerosis (MS) develop severe (Expanded Disability Status Scale [EDSS]  of 6.0 or greater) sustained (greater than 6 months) disability due to an acute relapse. Khemissa Bejaoui, PhD; Loren A. Rolak, MD Neurology� 2010;74:900�902


Authors aimed to establish the risk of permanent disability from an MS relapse and determine whether high-risk patients can be identified in advance, the outcomes of all relapses in patients seen in a specialized MS clinic were analyzed. Data on relapses was collected prospectively since 1994.
Among the 1,078 patients in the Marshfield Multiple Sclerosis Center, there were 2,587 relapses (mean of 2.4 per patient, with a range of 1–11 attacks over 1–15 years). Only 7 patients had a relapse resulting in EDSS 6 or greater that did not recover. Genetic analysis showed no difference in HLA-DR or NOS2A loci between these patients and other MS populations, nor were there any clinical factors that identified high risk. Two of these patients were on interferon treatment at the time of their disabling attack.

Authors conclude that the fear of a sudden irreversible disability should not influence therapeutic decisions because such attacks are very rare and can occur whether or not patients are treated with interferons.


National Research and Programs
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