Helen L.Tremlett, University of British Columbia, Medicine (Neurology), Rm. S178, UBC Hospital, 2211 Wesbrook Mall, University of British Columbia,Vancouver, BC. V6T 2B5tremlett@interchange.ubc.ca
Ana-Luiza Sayao and Virginia Devonshire
Submitted April 24, 2007
Drs. Amato and DeStefano provide a valuable update to the benign MS literature by
highlighting further data that was published subsequent to our paper being submitted to Neurology.
We agree that benign MS cannot be defined
or described solely on the use of somewhat arbitary cut-offs on the EDSS
scale. We found that reasonably high proportions of
patients progressing to ‘not benign’ after 20 years despite a relatively
low EDSS score at 10 years. [1] Furthermore, we were unable to find robust
predictors of who would remain ‘benign’ in the risk factors available to
us (onset age, gender, onset symptoms and EDSS score at 10 years).
The
limitations of the EDSS scale are well-known and we acknowledge
that patients with low EDSS scores may have marked disability caused
by symptoms not readily reflected by the scale such as fatigue, cognitive
or functional impairments. [1] Few studies have previously addressed this issue and we are encouraged by the additional studies cited by Dr. Amato et al. [2,3]
Despite these advances, defining and predicting benign MS remains a challenge. Patients who do remain ‘benign’ over extended time
may provide insight into what is required to modulate the disease process,
perhaps prompting new therapeutic strategies.
Disclosure: The authors report no conflicts of interest.
Drs. Amato and DeStefano provide a valuable update to the benign MS literature by highlighting further data that was published subsequent to our paper being submitted to Neurology.
We agree that benign MS cannot be defined or described solely on the use of somewhat arbitary cut-offs on the EDSS scale. We found that reasonably high proportions of patients progressing to ‘not benign’ after 20 years despite a relatively low EDSS score at 10 years. [1] Furthermore, we were unable to find robust predictors of who would remain ‘benign’ in the risk factors available to us (onset age, gender, onset symptoms and EDSS score at 10 years).
The limitations of the EDSS scale are well-known and we acknowledge that patients with low EDSS scores may have marked disability caused by symptoms not readily reflected by the scale such as fatigue, cognitive or functional impairments. [1] Few studies have previously addressed this issue and we are encouraged by the additional studies cited by Dr. Amato et al. [2,3]
Despite these advances, defining and predicting benign MS remains a challenge. Patients who do remain ‘benign’ over extended time may provide insight into what is required to modulate the disease process, perhaps prompting new therapeutic strategies.
Disclosure: The authors report no conflicts of interest.