Clinical characteristics, course and prognosis of spinal multiple sclerosis

Study design: Retrospective examination. Objective: To define the clinical characteristics and response to therapy of spinal multiple sclerosis ( MS). Setting: Italy. Methods: Retrospective review was performed on 563 patients with clinical definite MS. Selection criteria were two or more spinal cord lesions in the presence of normal magnetic resonance imaging of the brain. Results: Spinal MS was diagnosed in 13 patients ( 2.3%) out of 563 with clinical definite MS. There were seven female and six male patients; nine had a relapsing - remitting ( RR) and four, a primary progressive ( PP) course. All patients were treated with immunosoppressive or immunomodulatory therapy. Mean disease duration in patients with RR - MS was 13.1 +/- 10.1 years with a mean age at onset of 29.5 +/- 14.3 years; the mean Expanded Disability Status Scale ( EDSS) at the time of the study was 3.5 +/- 2.5 with a progression index of 0.28. Mean disease duration in patients with PP course was 7 +/- 6.2 years with a mean age at onset of 56.7 +/- 10.4 years; the mean EDSS at the time of the study was 6.2 +/- 2.0 with a progression index of 1.48. Conclusions: Patients with spinal RR - MS are characterised by an early disease onset with minimal or moderate disability progression; patients with spinal PP - MS show a late disease onset and more rapid disability progression. In our series of spinal MS patients, disability progression seems to be mainly due to the disease course and age at onset rather than to the site of lesion.