Predictive Factors Of Rapid Clinical Disability Progression In Remittent Recurrent Forms Of Tunisian Multiple Sclerosis

Background: Since 2006, our country became rated among regions of medium prevalence for multiple sclerosis (MS). A great interest is actually carried to MS. Little is known about long-standing and disabling MS. Objective: We propose to study predictive factors of poor prognosis in short (1-5 years), medium (5-10 years) and long term (>10 years). Patients and methods: We have conducted a retrospective study including remittent recurrent (RR) MS patients in whom the disease evolved since at least one year. Prognostic factors were evaluated using Progression index (EDSS/ disease duration), time to assess EDSS 4 and time to assess EDSS 6. Results: 116 patients were included. Predictive factors of rapid clinical disability progression were: late onset, polysymptomatic onset, motor signs and high EDSS at onset, incomplete recovery after the first relapse, short time between first and second relapse, high IgG index, infra-tentorial and medullar lesions on baseline MRI. We noted that whatever was the disease duration, initial clinical and paraclinical data no longer influenced clinical course of the disease once EDSS 4 was reached. Only two factors influenced this stage: high IgG index and presence of medullar lesions on baseline MRI. Conclusions: These findings support the hypothesis of presence of two stages in MS: First stage would be inflammatory and its evolution is in relation with different factors cited. Second stage would be degenerative and begin once EDSS 4 was reached. Determination of predictive factors could be a first step for establishing a multifactor and consensual prognostic index for MS disease.