cqvip:Background and objective: Multiple sclerosis (MS) is a chronic, progressive di sease of the central nervous system that generally occurs in adults under the ag e of 40 years and ultimately leads to severe neurological disability. Following the progression of MS by monitoring changes in disability levels can facilitate treatment decisions taken by physicians. The aim of this review is to present lo ngitudinal disability curves enabling the assessment of disease progression in p atients with relapsingremitting (RR)MS. Methods: Patients with a definite diagno sis of MS and an RR disease course were identified using the Multiple Sclerosis Center computerised database. Patients were stratified into major percentile gro ups based on their Expanded Disability Status Scale (EDSS) score 1 year after di sease onset. Model disability curves for each percentile were constructed using mean consecutive EDSS scores for 10 years after disease onset. Model curves were generated by smoothing (parametric and non parametric regression) and curve ap proximation (lin ear regression and moving averages). The predictive ability of model curves was validated by superimposing data from a separate group of patie nts with RRMS. Results: Disability curves were constructed using data from 1001 patients. A significant difference between the initial percentile assignment and disability progression was indicated by the log rank test (p <0.001). Kaplan Meier and life table analyses demonstrated the validity of the model in predicti ng disease progression. The probability of experiencing more severe disability t han predicted (i. e. deviating from the initial percentile to a higher percentil e over time) ranged from 6.5%(50 th percentile) to 15.4%(75th percentile), whi le the probability of experiencing less severe disability than predicted (i. e. deviating from the initially assigned percentile to a lower percentile over time ) ranged from 6.9%(50th percentile) to 1.6%(75th percentile). Both suggest rea sonable predictive validity. Conclusion: In MS, longitudinal disability curves c an help to assess individual patient disability, map the effects of immunomodula tory treatments over time, and generally build on the overall clinical impressio n of disease progression. Such models can act as a tool to aid and support the c linical decision making process. This review is based on the study published in Multiple Sclerosis (2003) 9:486-491.
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