| Popis: |
From a series of 476 definite and 51 probable cases of multiple sclerosis in the U.S. Army in the World War II period, factors predictive of the later course of the illness were sought. At 10 and 15 yr after diagnosis in about 20% of the patients the disease was ‘benign’ (Disability Status Scale (DSS) score 0–2), and in about 50% ‘severe’ (DSS score 6 +, including deaths). Demographic and sociologic variables known to be related to the risk of MS did not predict the course of illness over the 15 yr after Army diagnosis. Symptoms at onset, the frequency of bouts during the first 5 yr of illness, age, and laboratory findings at diagnosis were not related to the subsequent course of illness. There were statistically significant associations between severity of illness at 10 and 15 yr after diagnosis and several aspects of the disease observed at the time of first Army diagnosis, but the correlations with later status were quite low, with multiple correlation coefficients (R) ranging from 0.2 to 0.4. In contrast, neurologic status 5 yr after onset was highly predictive of the later course. The correlation coefficients between DSS scores at 5 yr after onset and those at 10 and 15 yr after diagnosis were about 0.8 for Group B patients (onset at Army diagnosis), 0.6 for Group A patients (bouts before Army diagnosis), and 0.7 for both onset groups combined. Among men with benign disease (DSS 0–2) 5 yr after onset, 2 3 still had benign disease 15 yr after diagnosis and in only 1 10 was it severe (DSS 6 +). Among the severely affected 5 yr after onset, only one in 71 was benign 15 yr after diagnosis, and all others remained severely affected. Aside from the DSS itself, the best predictors of later course were the 5-yr pyramidal and cerebellar scores, being together nearly as good as the DSS. For patients with neither pyramidal nor cerebellar signs 5 yr after onset, the percentage with DSS scores of 0–2, 10 and 15 yr after diagnosis ranged from 55 to 80, and that with DSS of 6 +, from 0 to 6%. For those with moderate or severe involvement (scores 3 +) in both pyramidal and cerebellar systems at 5 yr, the percentage with severe impairment at follow-up was 68–94, and none had a DSS score less than 3. |
