Predictors of Disability and Disease Progression among a Sample of Multiple Sclerosis Patients: An Egyptian Study

Abstract Background Diagnosing secondary progressive multiple sclerosis (SPMS) requires careful examination of the gradual decline that occurs following an initial relapsing-remitting multiple sclerosis (RRMS) course. Unfortunately, a lack of definitive criteria for determining when RRMS transitions to SPMS poses a challenge to accurately studying the differences between the two stages of the disease. Objective In this study, we aim to discover the potential predictors of disability and disease progression in Egyptian multiple sclerosis (MS) patients. Methods This retrospective hospital-based cohort study included 3123 patients diagnosed with multiple sclerosis (MS) - according to the revised McDonald criteria 2017- recruited from the registry of the MS unit at Ain Shams University over 2 years; and their demographic, clinical, and MRI data were collected. Results during the study period; 213 (6.82%) patients were found to be SPMS, and 17 of them dropped out during the study. Females represented 132 (67.35%), the mean age at the onset of the disease was 26.75 ± 8.4 (SD) years. While the mean duration of illness was 16.11 ± 7.49 (SD) years. The mean EDSS of the patients was 6.056 ± 1.36 and the mean number of relapses in the first 2 years was 2.95 ± 1.67 (SD) years. The number and types of MRI lesions both at baseline and last available one (T2, T1 black holes) in the different anatomical locations (FLAIR) (periventricular, juxtacortical, infratentorial, and spinal) were correlated with the clinical and demographic data of the patients as well as with the EDSS score. The presence of periventricular and spinal cord lesions and brain atrophy at baseline were significantly correlated to high EDSS scores (P < 0.001, P = 0.038 and P = 0.002) respectively. Also, the number of T2 lesions more than 10 was significantly correlated to the progression of the EDSS scores (P = 0.007) after linear regression analysis. Conclusion This study showed that the predictors of disability and disease progression in Egyptian MS patients include male gender, higher age at the onset of disease, increased number of disease relapses in the first 2 years, the presence of spinal cord lesions, brain atrophy, and more than 10 T2 lesion at the baseline MRI.