Solveig B Glad

Objective To study employment in benign multiple sclerosis (MS), the frequency of employment was analysed and the effect of early clinical and demographic factors on time to disability pension was evaluated in a population based MS cohort. The frequency of depression, cognitive function, fatigue and pain between benign and non-benign MS patients was compared, and their impact on employment in benign MS was studied. Methods All 188 patients alive, including 60 benign patients with onset of MS during 1976–1986 in Hordaland County, Western Norway, were interviewed and clinically examined in 2003. The Expanded Disability Status Scale (EDSS), depression (Beck Depression Inventory), cognitive function, fatigue, pain, year of disability pension, employment and type of occupation were registered. Benign MS was defined as an EDSS score ≤3.0 at least 10 years after disease onset. Results After a mean disease duration of 22.2 years, 32.4% of the cohort were still employed. A relapsing–remitting course, higher educational level and light physical work were significantly associated with longer time to disability pension in the general MS population. Thirty-nine (65.0%) benign MS patients were employed, independent of light or heavy physical work. Mild depressive symptoms were markedly associated with not being employed in benign MS (OR=7.3). Conclusions A relapsing–remitting course, higher educational level and light physical work significantly predicted longer time to disability pension in the total MS population. Among the benign MS patients, depressive symptoms, although mild, were strongly associated with not being employed.

To investigate the impact of different definitions on the frequency of benign multiple sclerosis (MS) in patients with a long follow-up, and to study the presence of non-motor symptoms and employment across the definitions. All patients alive (n = 188) with disease onset during 1976-1986 in Hordaland County, Norway, were clinically examined including the Expanded Disability Status Scale (EDSS) in 2003. Non-motor symptoms which included depression, cognitive impairment, fatigue and pain, and employment status were also registered. Three definitions of benign MS were used based on the following EDSS cut-off values: 2.0, 3.0 and 4.0. Two additional definitions were added using an EDSS <or=4.0 and incorporating either full-time or full- and part-time employment status. The frequency of benign MS increased from 14.5% for EDSS <or=2.0 to 40.8% for EDSS <or=4.0, but was only 12.3% for the definition based on full-time employment. Patients with an EDSS <or=2.0 had markedly less non-motor symptoms and lower unemployment rates than the other groups. An EDSS score <or=2.0 with at least 10 years of disease duration seems to be the most appropriate criterion in identifying patients with benign MS.

Objective To study the frequency of benign multiple sclerosis (MS) after 20 years disease duration and identify early clinical and demographic prognostic factors of a benign course. Methods A population-based cohort including all 230 MS patients with clinical disease onset during 1976–1986 in Hordaland County, Western Norway was followed up with clinical examination in 1995 and 2003. Benign MS was defined as an Expanded Disability Status Scale (EDSS) score ≤3.0, at least 10 years after disease onset. Results A relapsing–remitting disease course at onset, female gender, and younger age at onset were significantly associated with a benign course, but could only explain 23.0% of the variation in the benign course. A low annual relapse rate was also associated with a benign course. When including this variable in the model, 42.3% of the variation could be explained. The number of benign MS cases decreased significantly from 37.6% in 1995 to 24.2% in 2003. Conclusion Benign MS is frequently a temporary condition. Only a small part of the variation in the long-term benign course could be explained by clinical data present in the early phase of the disease. With several new emerging therapies in MS, the need for more reliable prognostic factors is increasing, to improve and individualize patient treatment.