Department of Neurology, Institute for Neurological Research Raúl Carrea, FLENI, Buenos Aires, Argentina.
Mult Scler. 2012 Feb;18(2):210-8. doi: 10.1177/1352458511419702. Epub 2011 Aug 24.
To study a cohort of benign multiple sclerosis (BMS) patients beyond physical disability, including the evaluation of cognitive and social function, as well as fatigue, pain and MRI studies.
A cohort of 342 patients was prospectively followed for 10.9 ± 0.71 years. Forty-three patients (12.5%) met the BMS diagnosis criteria [Expanded Disability Status Scale (EDSS) < 3 after at least 10 years' disease duration], undergoing full neurological examination every 6 months. Neuropsychological status, pain, fatigue, social functioning and work-related disability, as well as brain MRIs, were assessed yearly.
By the end of follow-up, 20 of 43 BMS patients (47%) had suffered cognitive impairment and 23 (53.3%) referred depression. Furthermore, 21 (48.8%) reported significant changes in pain intensity, with fatigue and environmental severity scores significantly increasing over time in 33-35% of patients. Finally, 32 BMS patients (74%) showed significant increase in the number of new or enlarging T2 lesions, gadolinium-enhanced lesions, and persistent black holes, without changes in EDSS. Thirty-five of 43 patients (81%) fulfilling the BMS diagnostic criteria showed significant worsening of cognitive function, fatigue, pain or depression during the 10-year follow-up.
Currently accepted criteria for BMS diagnosis may cause overestimation of true prevalence, underscoring the need for routine monitoring of non-motor symptoms and imaging studies, to help physicians improve diagnostic accuracy as well as therapeutic decision-making in this subgroup of MS patients.
研究一组良性多发性硬化症（BMS）患者，超越身体残疾，包括认知和社会功能评估，以及疲劳、疼痛和 MRI 研究。
前瞻性随访了 342 例患者，随访时间为 10.9±0.71 年。43 例（12.5%）符合 BMS 诊断标准[扩展残疾状况量表（EDSS）<3 年，至少 10 年病程]，每 6 个月进行一次全面的神经系统检查。每年评估神经心理学状态、疼痛、疲劳、社会功能和与工作相关的残疾，以及脑 MRI。
随访结束时，43 例 BMS 患者中有 20 例（47%）出现认知障碍，23 例（53.3%）出现抑郁。此外，21 例（48.8%）报告疼痛强度显著变化，疲劳和环境严重程度评分在 33-35%的患者中随时间显著增加。最后，32 例 BMS 患者（74%）显示新或扩大的 T2 病变、钆增强病变和持续黑洞的数量显著增加，而 EDSS 无变化。43 例符合 BMS 诊断标准的患者中有 35 例（81%）在 10 年随访期间认知功能、疲劳、疼痛或抑郁显著恶化。
目前用于 BMS 诊断的标准可能导致对真实患病率的高估，强调需要常规监测非运动症状和影像学研究，以帮助医生提高这组 MS 患者的诊断准确性和治疗决策。
