Key result
Between 30% and 80% of relapsing-remitting multiple sclerosis patients have an EDSS < 3 or 4 at 10 years after onset, with a single relapse in the first 5 years and low early EDSS strongly predicting a prolonged benign course.
Systematic Review
Current definitions of benign multiple sclerosis have some predictive value for future physical disability but fail to account for non-motor symptoms, limiting their clinical relevance.
Early predictors identify benign RRMS trajectories; confirms definitions' value for physical disability while highlighting gaps for non-motor outcomes.
BACKGROUND: Multiple sclerosis (MS) is characterized by a great inter-individual variability in disease course and severity. Some patients experience a rather mild course, controversially called 'benign MS' (BMS). The usefulness of this entity in clinical practice remains unclear. METHODS: and predefined inclusion criteria. RESULTS: Our search yielded 26 publications. Most definitions were based on the Expanded Disease Status Scale (EDSS), which is heavily weighted towards physical disability. Between 30 and 80% of relapsing-remitting MS patients have EDSS < 3 or 4 at 10 years after onset. Having only one relapse in the first 5 years and EDSS ≤ 2 at 5 years or EDSS ≤ 3 at 10 years appears to be predictive for a prolonged benign disease course, without protecting against disease progression at a later stage. Evidence on the predictive value of MRI parameters remains limited. CONCLUSIONS: Current BMS definitions have some predictive value for future physical disability, but do not take into account the age at EDSS and the potentially disrupting effects of non-EDSS symptoms and cognitive impairment. It appears to correspond to mild RRMS in the first decades and its prevalence varies. Since early and accurate prediction of BMS is not yet possible, the clinical relevance is limited. Research approaches are suggested.
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Reynders et al. (2017) conducted a systematic review in Benign multiple sclerosis. Predictors of benign multiple sclerosis (e.g., single relapse in first 5 years, low early EDSS) vs. Absence of these predictors was evaluated on Probability of having benign multiple sclerosis (EDSS ≤ 3 or 4 at ≥ 10 years). Between 30% and 80% of relapsing-remitting multiple sclerosis patients have an EDSS < 3 or 4 at 10 years after onset, with a single relapse in the first 5 years and low early EDSS strongly predicting a prolonged benign course.
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