Clinical Characteristics And Prognosis Analysis In In-patients With Multiple Sclerosis For Twenty Years

【Objective】Firstly, through retrospectively analyzing medical records of patients with multiplesclerosis (MS), we summarized the clinical manifestations of MS for early diagnosis.Secondly, combining the patients' medical records and Expanded Disability Status Scale(EDSS) score, we try to determine the prognostic factors of MS in order to direct futureclinical medication.【Methods】We studied the features of age, sex, inducing factor, symptoms at onset, presentsymptoms and signs, imaging findings, cerebrospinal fluid and neuro- electrophysiologicexaminations of 120 patients with MS, who were in the First Affiliated Hospital ofSoochow University, Second Affiliated Hospital of Soochow University and the SecondPeople's Hospital of Suzhou between 1987 and 2007. According to the neurologicimpairment condition of each person at initial hospitalization, initial discharge, finalhospitalization and final discharge, their EDSS scores were achieved and then, the EDSSscores were compared among different groups dividing in age, sex, symptoms at onset,interval between the first and second attack or individual clinical subtype, respectively.Quantitative data was analyzed by ANOVA.【Results】1. The frequency of vertigo and vomit at onset in our MS group is as high as 10.0%.2. 25% in 120 patients with MS appear paroxysmal symptoms, which predominantlypresent paroxysmal paresthesias (10.8%), tonic spasms(9.2%), Lhermitte (10.0%)and epilepsy (8.1%).3. In patients who presented sensory and optic symptoms at onset, relapsing-remitting MS(RRMS) accounts for 75% and 69.2% respectively, which are significantly higherthan secondary progressive MS (SPMS, 12.5% and 7.7%) and primary progressiveMS(PPMS,4.2% and 3.8%). 58.5% patients in SPMS present motor symptoms atonset.4. The positive ratio of VEP and SEP for MS are 66.0% and 64.3% respectively, which isremarkable higher than 54.7% in BAEP.5. In patients who presented sensory, optic, brainstem and cerebellar symptoms at onset,the EDSS score after treatment are: 3.1±2.1, 2.7±2.1 and 2.4±2.2, which aresignificantly lower than 4.5±2.4 (p＜0.05) in patients with motor symptoms at onset.6. After treatment, the EDSS score in female of age＜40 and male of age≥40 are 3.0±2.6 and 2.7±1.9, which significantly lower than 4.6±2.8 (p＜0.05) in women ofage≥40.7. After treatment, the EDSS score in patients with interval between the first and secondattack less than 2 years is 3.5±2.6, which is significantly higher than 2.4±2.0 in patientswith interval more than 2 years.8. The EDSS score in RRMS, SPMS, PPMS at initial hospitalization are: 4.6±1.9, 5.4±1.6 and 4.4±0.7, and there are no differences between them (p＞0.05). Aftertreatment, the score in SPMS and PPMS are: 7.0±1.7 and 7.0±1.6, which issignificantly higher than 2.3±1.8 (p＜0.05) in RRMS.9. The EDSS score of neuromyelitis optica (NMO) and classical MS are:3.6±1.3 and3.7±1.61 and there are no differences between them (p＞0.05). But after treatment, thescore of NMO is 4.1±2.8, which significantly higher than that of classical MS(2.7±2.7, p＜0.05).【Conclusions】1. The incidence of vertigo and vomit at onset in patients with MS is high.2. Paroxysmal symptoms can be seen in 25% MS patients, which can be considered ascharacteristic manifestations for MS.3. The evoked potential examinations, especially VEP and SEP, are helpful to patientswith clinical probable MS and may enhance the rate of diagnosis.4. Sex, age at onset, symptoms at onset, interval between the first and second attack allcan affect the prognosis of MS. Clinically, these factors can be used to judge the prognosis early and guide precaution and treatment decisions to alleviate the physicaldisability.