Assessment of functional profile and fatigue in Egyptian patients with active secondary progressive MS

Abstract Background Current longitudinal real-world data on secondary progressive multiple sclerosis (SPMS) remains limited, as most studies utilize cross-sectional designs that do not combine objective metrics with patient-reported outcomes like fatigue and depression. Therefore, integrating multidimensional assessments over time is essential to accurately capture disease evolution and treatment efficacy. Objectives To longitudinally evaluate clinical, cognitive, and functional progression in Egyptian patients with active SPMS over 12 months. Methods This prospective study included 46 Egyptian patients with active SPMS (69.6% females; mean age 43.5 years; mean disease duration 13.9 years). Patients were evaluated at baseline and followed for 12 months at 6-month intervals using Expanded Disability Status Scale (EDSS), Timed 25-Foot Walk Test (T25FWT), Nine-Hole Peg Test (9HPT), Symbol Digit Modalities Test (SDMT), Modified Fatigue Impact Scale (MFIS), and Beck Depression Inventory (BDI). Results Male sex and earlier multiple sclerosis (MS) onset were associated with earlier SPMS conversion and higher early relapse rates. Over 12 months, EDSS increased significantly, with concomitant worsening in motor performance, fatigue, depression, and cognition. Faster progression was observed in patients with baseline spinal cord involvement and higher relapse frequency. Conclusion Disease progression in SPMS is multidimensional. Integrating functional, cognitive, and patient-reported measures is crucial for comprehensive assessment and early detection of progression.