Abstract:
Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system with variable types of disability
progression (DP). Previous studies, defning diferent disability milestones (DMs), have reported symptoms at MS onset to
be the predictors of DP and sex as a risk factor. Meanwhile, accounting for sex diferences in MS, predictors in female and
male patients might difer. To investigate whether the symptoms at MS onset predict reaching DMs in patients with relapsing–remitting (RR) MS and whether the predictors vary between diferent DMs and female and male patients. Data from
128 RR MS patients (84 females, 44 males) was retrospectively studied. EDSS scores 4 and 6 (associated with impaired
ambulation) were taken as DMs. Association between symptoms at MS onset and time to reach DMs was assessed with Cox
multiple regression model. Pyramidal symptoms and fatigue at MS onset predicted the progression to EDSS 4 in the whole
study population (HR 1.84, 95% CI 1.07–3.2, p=0.028 and HR 2.01, 95% CI 1.12–3.4, p=0.011, correspondingly). The same
symptoms predicted reaching DM in female, but not male patients. Bowel/bladder symptoms predicted reaching EDSS 6 in
the whole study population (HR 4.31, 95% CI 1.47–12.6, p=0.008) and female patients only (HR 3.93, 95% CI 1.04–14.8,
p=0.043). In female patients, fatigue was also the predictor of reaching EDSS 6 (HR 3.54, 95% CI 1.16–10.8, p=0.026).
Impairment of functional symptoms at MS onset can predict reaching DMs in patients with RR-MS, but the predictors for
EDSS 4 and EDSS 6 difer in female and male patients.
