LAUSR

Multiple sclerosis (MS) disease course is greatly changed over the last decades. The accuracy and the promptness of the diagnostic process, as well as the availability of ever more effective disease modifying therapies (DMTs), lead to a more favorable evolution of the disease. As a consequence, the occurrence of severe disability and death due to MS is less frequent [1]. The present study aims to take a picture of the current MS framework comparing the clinical course of a recent MS cohort with the courses of two previous cohorts followed in the same setting and selected through the same design [2, 3], to show how the real-world scenario of the disease is changed over 30 years. The Ethic Committee of San Raffaele Hospital, Milan, Italy, approved the observational study protocol (212/2016; date 8th Sep 2016), and all subjects signed informed consent form. We included all the patients fulfilling the same criteria that were applied in two previous studies [1, 2]: first hospitalization at the MS Center at IRCCS Mondino Foundation, Pavia, northern Italy (in the case of the present study from 1 January 2005 to 31 December 2006), residence in northern Italy, diagnosis of definite or probable or possible MS according to McAlpine’s criteria [4]. Of note, despite very old, we have chosen the same diagnostic criteria employed in the previous studies [2, 3] to assure the comparability of the records. MS diagnosis was confirmed during follow-up in all cases on the basis of clinical and instrumental findings (brain MRI and cerebrospinal fluid examinations). In particular, all patients with relapsing onset developed clinically definite MS, and all patients with primary-progressive onset had a clinical evolution and MRI findings confirming the diagnosis of MS. Clinical examinations, performed from June 2018 to December 2018 by a senior neurologist of our group (RB), provided information concerning the individual neurological status of the living patients. When a patient could not perform the visit at MS Center or he/she was referred to another MS Center, information was collected from the patient or the caregiver by the senior neurologist of our group (RB) via telephone call. We subdivided the patients in four groups on the basis of Kurtzke’s EDSS [5]: no disability (EDSS = 0–1.5), mild disability (EDSS = 2.0–4.5), moderate disability (EDSS = 5–6.5) and severe disability (EDSS > 6.5). The data collected in the present study were compared with those coming from the two previous analogous studies: