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The natural history of multiple sclerosis
Open accessAbstract
The course of multiple sclerosis (MS) results from the interplay of two clinical processes, relapses and progression. Three main clinical forms may be identified as relapsing-remitting, secondary progressive and primary progressive. The disease appears on average at the age of 30 and follows a remitting or a progressive course in 85% and 15% of the cases, respectively. Initial symptoms are related to an isolated or combined disturbance(s) of the long tracts of the central nervous system, of the brainstem, or of the optic nerve in 70%, 20% and 25% of the cases, respectively. The relapse rate is one relapse on average every other year. After an exacerbating-remitting onset of MS, secondary progression appears after 19 years on average. The median time to reach the landmarks of irreversible disability are 8 years regarding limitation of ambulation, 20 years for walking with a stick, and 30 years for wheel-chair dependency. In fact, MS prognosis is highly variable depending on individuals. All the intermediate types do exist between malignant forms, possibly lethal, and benign forms (circa 30% of the cases) that allow normal daily life. The clinical and paraclinical predictive factors identified so far have been acknowledged statistically. They provide little help however, if any, when an individual is concerned. Recent research has showed that relapses have only a marginal effect, relatively to progression, on the accumulation of irreversible neurological disability. Furthermore, the age when reaching the landmarks of irreversible disability is essentially similar whatever the mode of onset of MS, be it exacerbating-remitting or progressive. In spite of the outstanding clinical polymorphism of MS, a unifying concept of the disease ("complexity vs heterogeneity") can be put forward.
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“The largest single risk factor for MS is biological sex, with > 75% of patients being female – but the causes for this discrepancy in incidence are unknown.73”
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“The largest single risk factor for MS is biological sex, with > 75% of patients being female – but the causes for this discrepancy in incidence are unknown.73”
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“MS is also a remarkably heterogeneous disease, with some patients declining rapidly and others showing few or no symptoms for decades.73”
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Metadata
- Authors
- Confavreux, C., & Compston, A.
- Affiliations
- Inserm (FR)
- ORCID
- Compston, Alastair
- Venue
- McAlpine's Multiple Sclerosis
- Publisher
- Elsevier
- Published
- 2006
- Volume
- 56
- Issue
- 12
- Pages
- 183-272
- PMC
- PMC7173457
- OpenAlex
- W111819890
- Cited by
- 166
- References
- 0
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 12 · 2023: 1 · 2022: 6 · 2021: 2 · 2020: 5 · 2019: 7 · 2018: 8 · 2017: 7 · 2016: 15 · 2015: 9 · 2014: 11 · 2013: 7 · 2012: 7
- FWCI
- 62.74
- Type
- book chapter
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Elsevier eBooks (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Oncology › Polyomavirus and related diseases
- Health Sciences › Medicine › Clinical Neurology › Peripheral Neuropathies and Disorders
- Keywords
- multiple sclerosis, clinical course, relapse, disease progression, relapsing-remitting multiple sclerosis, secondary progressive multiple sclerosis, primary progressive multiple sclerosis, disability progression, prognosis, predictive factors, disease heterogeneity
- MeSH terms
- Humans, Multiple Sclerosis, Prognosis, Disease Progression
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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