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Research paper
Characterising aggressive multiple sclerosis
  1. Suresh Menon1,
  2. Afsaneh Shirani2,
  3. Yinshan Zhao3,
  4. Joel Oger2,
  5. Anthony Traboulsee1,
  6. Mark S Freedman4,
  7. Helen Tremlett2
  1. 1Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
  2. 2Department of Medicine, Division of Neurology and Brain Research Centre, University of British Columbia, Vancouver, BC, Canada
  3. 3Department of Medicine, Division of Neurology, MS/MRI Research Group, University of British Columbia, Vancouver, British Columbia, Canada
  4. 4Multiple Sclerosis Research Unit, University of Ottawa, Ottawa, Ontario, Canada
  1. Correspondence to Dr Helen Tremlett, Faculty of Medicine (Neurology), University of British Columbia, Rm S178, UBC Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5; helen.tremlett{at}


Objective To explore the occurrence and characteristics of aggressive multiple sclerosis (AMS) in adult-onset multiple sclerosis (MS) patients.

Methods Prospectively collected data (1980–2009) from British Columbia, Canada, were retrospectively analysed. AMS was defined in three different ways (AMS1, 2 and 3): ‘AMS1’—confirmed Expanded Disability Status Scale (EDSS) ≥6 within 5 years of MS onset; ‘AMS2’—confirmed EDSS ≥6 by age 40; and ‘AMS3’—secondary progressive MS within 3 years of a relapsing-onset course. Three respective ‘non-aggressive’ MS comparison cohorts were selected. Patients’ characteristics were compared between aggressive and non-aggressive cohorts using multivariable logistic regression, with findings expressed as adjusted OR (AOR) and 95% CI.

Results Application of the three definitions to the source population of 5891 patients resulted in 235/4285 (5.5%) patients fulfilling criteria for AMS1 (59.6% were female; 74.5% had relapsing-onset MS), 388/2762 (14.0%) for AMS2 (65.2% were female; 92.8% had relapsing-onset MS) and 195/4918 (4.0%) patients for AMS3 (61.0% were female). Compared to the respective control cohorts, those with AMS were more likely to be male (AOR=1.5, 95% CI 1.1 to 2.0 (AMS1); 1.6, 95% CI 1.3 to 2.1 (AMS2); 1.8, 95% CI 1.3 to 2.4 (AMS3)), older at MS symptom onset (AOR=1.1; 95% CI 1.1 to 1.1 (AMS1 and AMS3)) and have primary progressive MS (AOR=2.3, 95% CI 1.6 to 3.3 (AMS1); 2.7, 95% CI 1.7 to 4.4 (AMS2)).

Conclusions AMS was identified in 4–14% of patients, depending on the definition used. Although there was a relative preponderance of men and primary progressive MS presenting with AMS, the majority of patients were still women and those with relapsing-onset MS.


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