W. Poser

Multiple sclerosis and gestation

The gestational history of 512 women with multiple sclerosis revealed that the risk of MS-onset, exacerbation, or progression was two to three times as high during the 6 months after childbirth as during pregnancy. Using a progression-index as a measure of prognosis (disability divided by duration), the speed of deterioration was comparable for women who became pregnant and those who did not. An apparent but insignificant trend toward better prognosis for women with pregnancies after MS-onset was most likely due to their younger age at onset. The natural course of pregnancy and childbirth was comparable among women pregnant before and during the disease. There was no evidence of an increased frequency of congenital malformations in the offsprings.

Age at onset, initial symptomatology and the course of multiple sclerosis

Analysis of the initial symptomatology, age at onset and course as factors influencing the prognosis of multiple sclerosis (MS) revealed that the rate of deterioration in a sample of 1,571 patients ‐ registered during a neurological examination in a standardized way ‐ was slower for patients with optic neuritis as the initial sign, for patients with an age at onset of under 39 years and for patients with a remissive course of disease.

Survival in multiple sclerosis

Survival from onset of symptoms was calculated for two series of MS patients, a population-based epidemiologic series from southern Lower Saxony of 224 cases, and a revised hospital series of 1429 cases from 11 neurologic centers throughout the Federal Republic of Germany. Median survival for the epidemiologic series was 35-42 years, with no finer estimate possible. Observed survival was 3/5 expected survival after 35 years of illness. Survival in this series was similar to that from two other population-based reports. No significant difference was found between the sexes, though patients with onset at age 35 + had a significantly shorter survival than those with onset at age under 35 years. The much larger hospital series, where median survival was 30 years, demonstrated significant differences separately favoring females and young onsets. However, the ratios of observed to expected survival from population life tables were strikingly similar among all four subgroups defined by sex and age at onset. While overall there is a substantial reduction in the expectation of life in MS, the differential survival by sex and age appears to be a reflection of the expected survival by sex and age per se, and not that of the disease.

Pregnancy, oral contraceptives and multiple sclerosis*

All female patients with Multiple Sclerosis (MS) from an epidemiological area of Southern Lower Saxony completed a questionnaire in connection with a standardized neurological examination.

Prognostic indicators in multiple sclerosis

Abstract The influence of sex, age at onset, course of the disease and initial symptomatology on the mortality of patients with multiple sclerosis is analysed. A sample of 1926 patients was followed up prospectively over 4.9 years. Both, the mortality ratio (number of observed to expected deaths) and the excess death rate are calculated. Whereas the mortality ratio as a parameter of overall mortality is influenced by a variety of factors, such as age and sex; the excess death rate represents the number of extra deaths per 1000 exposed to risk in an indicated year and is, therefore, a parameter of the mortality which is attributed to MS. The excess death rate was comparable for the sexes, it was slightly higher for patients with a higher age at onset and it was clearly higher for the progressive course. Patients with initial diplopia and sensory signs and symptoms had the lowest excess death rate, whereas patients with pareses, cerebral and sphincter disturbances at onset showed the highest excess death rate.

Mortality in patients with dependence on prescription drugs

In 1974 we started a follow-up of patients with different psychoactive substance use disorders (PSUD) according to DSM-III; 2082 cases out of 2127 were analyzed; 1370 patients had taken legal drugs (i.e. prescription drugs and/or over-the-counter drugs); 444 patients suffered from abuse or dependence of legal drugs alone; 678 combined legal drugs and ethanol, and 248 cases combined legal and illegal drugs, often together with ethanol. A group of 712 alcoholics were included for comparison. Mean time under observation was 6.5 +/- 5.4 years, and 269 patients died. Mortality and survival were calculated and compared with expected survival from the normal population of the former Federal Republic of Germany. Mortality in all subgroups of PSUD was increased, the standardized mortality ratio (SMR) for patients on legal drugs alone being 2.1. Patients with legal plus illegal drugs had a SMR as high as 20.7; those with legal drugs plus ethanol 3.4; and alcoholics 4.2. The increased mortality seemed to be constant over the years. Mortality decreased in patients with stable abstinence. There was no clear sex difference. Abuse had a better prognosis than dependence. An estimation of potential life lost by the different PSUDs was attempted. Patients on legal drugs died from suicides, malignancies or accidents (including intoxication). In alcoholics or patients on legal drugs plus ethanol malignoma, liver cirrhosis, accident and suicide were the most prominent causes of death.

Clinical Features of the Spinal Form of Multiple Sclerosis

Out of a data pool of 1271 patients with Multiple Sclerosis (MS) a total of 109 cases are selected having a sole spinal symptomatology throughout the course of the disease. This group differs in three particular features from the non‐spinal forms of MS: In this group there is a higher percentage of females, the age at onset of the disease is higher, and the course of the disease is more often chronic progressive from the beginning.