The Benign form of Multiple Sclerosis: Results of a Long-term Study

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Abstract
In 1959 the results of a follow-up of 241 cases of multiple sclerosis seen within 3 years of onset and observed for 10 years or more showed that 78 (32%) were not disabled and were at work. In the spring of 1964, 63 of the 78 patients were re-examined; information about the remainder was obtained by letter. Results: dead, 3 (from an unrelated cause); disabled 12; unrestricted, 62 ; untraced 1. The mean duration of the disease was 18.2 years. Thirty-nine patients were aged 50 or over. Presenting symptoms were paraesthesiae in 50%, acute retrobulbar neuritis in 36%, and motor weakness in 34%. A comparison of pyramidal and cerebellar signs observed within 3 years of onset and after 15 years confirms their importance in determining whether or not the disease will run a benign course. Early bilateral extensor plantar responses with little or no impairment of motor power were, however, present in 15 out of 62 patients still without disablement. Pallor of one or both optic disks was present in 73%, nystagmus in 31%, and euphoria in 16% of the 63 patients examined in 1964. So far 14 of the 74 patients have not relapsed. In some of these patients, however, old or fresh signs have been observed during the follow-up period. An assessment of signs and relapse rate in the 62 patients at present without disablement suggests that roughly 50 of them-that is, 20% of the original 241-may still be in category unrestricted in 1965, after a mean duration exceeding 20 years. A comparison of admission rates in the 1st year of the disease in the original series of 241 patients who subsequently died, became disabled, or were unrestricted in 1959 suggests that early hospital care may be a factor in modifying the course of the disease, as may the introduction of ACTH as a therapeutic agent.