Vol 54, No 2 (2020)
Research Paper
Published online: 2020-04-03

open access

Page views 1213
Article views/downloads 336
Get Citation

Connect on Social Media

Connect on Social Media

Demographic and clinical profile of patients with multiple sclerosis diagnosed over the last 30 years according to different diagnostic criteria

Joanna Przybek-Skrzypecka1, Inga Małecka2, Anna Członkowska2, Dagmara M. Mirowska-Guzel3
Pubmed: 32242912
Neurol Neurochir Pol 2020;54(2):169-175.


The aim of this study was to investigate the demographic and clinical characteristics of patients with multiple sclerosis (MS) diagnosed between 1986 and 2015. 333 patients with definite MS were divided into four subgroups according to the following diagnostic criteria: Group A) Poser (n = 145), Group B) McDonald 2000 (n = 66), Group C) McDonald 2005 (n = 62), and Group D) McDonald 2010 (n = 60). We investigated: 1) patient sex and age at diagnosis, 2) symptoms and number of relapses that prompted MS diagnosis, 3) time between first symptoms suggestive of MS and confirmed diagnosis, and 5) Expanded Disability Status Scale (EDSS) score at disease onset. The overall female-to-male ratio was 2.3:1, but in the subgroups it differed significantly (A — 1.9; B — 1.6; C — 4.7; D — 3.6). The mean age at diagnosis (in years) decreased from 39.6 ± 13.3 in Group A to 29.9 ± 9.3 in Group D, p < 0.001. Pyramidal signs remained the most common manifestation regardless of the diagnostic criteria, although an increased trend of visual dysfunction was observed (A — 16%, B — 14%, C — 19%, D — 23,3%; A vs D, p < 0.001). The number of relapses before diagnosis decreased from median 4.0 to 2.5 in Group A and Group D, p < 0.001. Time from the first symptom to diagnosis shortened from 88.9 ± 80.2 months (Group A) to 33.6 ± 68.2 months (Group D), p < 0.0001. Mean EDSS score at diagnosis also decreased: A — 4.4 ± 2.3; B — 3.1 ± 1.7; C — 2.7 ± 1.3; D — 2.8 ± 1.4, p < 0.001. Our study indicates significant differences in demographic and clinical characteristics of MS diagnosed according to the changing criteria.

Article available in PDF format

View PDF Download PDF file


  1. Lunde HM, Assmus J, Myhr KM, et al. Survival and cause of death in multiple sclerosis: a 60-year longitudinal population study. J Neurol Neurosurg Psychiatry. 2017; 88(8): 621–625.
  2. Tullman MJ. Overview of the epidemiology, diagnosis, and disease progression associated with multiple sclerosis. Am J Manag Care. 2013; 19(2 Suppl): S15–S20.
  3. Kingwell E, Zhu F, Marrie RA, et al. High incidence and increasing prevalence of multiple sclerosis in British Columbia, Canada: findings from over two decades (1991-2010). J Neurol. 2015; 262(10): 2352–2363.
  4. Ribbons K, Lea R, Tiedeman C, et al. Ongoing increase in incidence and prevalence of multiple sclerosis in Newcastle, Australia: A 50-year study. Mult Scler. 2017; 23(8): 1063–1071.
  5. Simonsen CS, Edland A, Berg-Hansen P, et al. High prevalence and increasing incidence of multiple sclerosis in the Norwegian county of Buskerud. Acta Neurol Scand. 2017; 135(4): 412–418.
  6. Mackenzie IS, Morant SV, Bloomfield GA, et al. Incidence and prevalence of multiple sclerosis in the UK 1990-2010: a descriptive study in the General Practice Research Database. J Neurol Neurosurg Psychiatry. 2014; 85(1): 76–84.
  7. Poser CM, Paty DW, Scheinberg L, et al. New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol. 1983; 13(3): 227–231.
  8. McDonald WI, Compston A, Edan G, et al. Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol. 2001; 50(1): 121–127.
  9. Polman CH, Reingold SC, Edan G, et al. Diagnostic criteria for multiple sclerosis: 2005 revisions to the "McDonald Criteria". Ann Neurol. 2005; 58(6): 840–846.
  10. Thompson AJ, Banwell BL, Barkhof F, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018; 17(2): 162–173.
  11. Stelmasiak Z, Bartosik-Psujek H, Belniak-Legieć E, et al. [Differential diagnosis in multiple sclerosis: description of selected cases]. Neurol Neurochir Pol. 2000; 34(3 Suppl): 45–53.
  12. Brownlee WJ, Hardy TA, Fazekas F, et al. Diagnosis of multiple sclerosis: progress and challenges. Lancet. 2017; 389(10076): 1336–1346.
  13. Kingwell E, Marriott JJ, Jetté N, et al. Incidence and prevalence of multiple sclerosis in Europe: a systematic review. BMC Neurol. 2013; 13: 128.
  14. Glaser A, Stahmann A, Meissner T, et al. Multiple sclerosis registries in Europe - An updated mapping survey. Mult Scler Relat Disord. 2019; 27: 171–178.
  15. Kułakowska A, Bartosik-Psujek H, Hożejowski R, et al. Selected aspects of the epidemiology of multiple sclerosis in Poland - a multicentre pilot study. Neurol Neurochir Pol. 2010; 44(5): 443–452.
  16. Brola W, Sobolewski P, Flaga S, et al. Increasing prevalence and incidence of multiple sclerosis in Poland. Neurol Neurochir Pol. 2017; 51(1): 82–85.
  17. Koch-Henriksen N, Thygesen LC, Stenager E, et al. Incidence of MS has increased markedly over six decades in Denmark particularly with late onset and in women. Neurology. 2018; 90(22): e1954–e1963.
  18. Höer A, Schiffhorst G, Zimmermann A, et al. Multiple sclerosis in Germany: data analysis of administrative prevalence and healthcare delivery in the statutory health system. BMC Health Serv Res. 2014; 14: 381.
  19. Brola W, Sobolewski P, Flaga S, et al. Prevalence and incidence of multiple sclerosis in central Poland, 2010-2014. BMC Neurol. 2016; 16(1): 134.
  20. Westerlind H, Boström I, Stawiarz L, et al. Sex ratio of multiple sclerosis in the National Swedish MS Register (SMSreg). Mult Scler. 2013; 19(1): 46–52.
  21. Heydarpour P, Khoshkish S, Abtahi S, et al. Multiple Sclerosis Epidemiology in Middle East and North Africa: A Systematic Review and Meta-Analysis. Neuroepidemiology. 2015; 44(4): 232–244.
  22. Kotzamani D, Panou T, Mastorodemos V, et al. Rising incidence of multiple sclerosis in females associated with urbanization. Neurology. 2012; 78(22): 1728–1735.
  23. Orton SM, Herrera BM, Yee IM, et al. Canadian Collaborative Study Group. Sex ratio of multiple sclerosis in Canada: a longitudinal study. Lancet Neurol. 2006; 5(11): 932–936.
  24. Pugliatti M, Cossu P, Sotgiu S, et al. Clustering of multiple sclerosis, age of onset and gender in Sardinia. J Neurol Sci. 2009; 286(1-2): 6–13.
  25. Maghzi AH, Ghazavi H, Ahsan M, et al. Increasing female preponderance of multiple sclerosis in Isfahan, Iran: a population-based study. Mult Scler. 2010; 16(3): 359–361.
  26. Osoegawa M, Kira J, Fukazawa T, et al. Research Committee of Neuroimmunological Diseases. Temporal changes and geographical differences in multiple sclerosis phenotypes in Japanese: nationwide survey results over 30 years. Mult Scler. 2009; 15(2): 159–173.
  27. Houzen H, Niino M, Hirotani M, et al. Increased prevalence, incidence, and female predominance of multiple sclerosis in northern Japan. J Neurol Sci. 2012; 323(1-2): 117–122.
  28. Rojas JI, Patrucco L, MIguez J, et al. Gender ratio trends over time in multiple sclerosis patients from Argentina. J Clin Neurosci. 2017; 38: 84–86.
  29. Boesen MS, Magyari M, Koch-Henriksen N, et al. Pediatric-onset multiple sclerosis and other acquired demyelinating syndromes of the central nervous system in Denmark during 1977-2015: A nationwide population-based incidence study. Mult Scler. 2018; 24(8): 1077–1086.
  30. Ortona E, Pierdominici M, Maselli A, et al. Sex-based differences in autoimmune diseases. Ann Ist Super Sanita. 2016; 52(2): 205–212.
  31. Bebo BF, Fox RJ, Lee K, et al. Landscape of MS patient cohorts and registries: Recommendations for maximizing impact. Mult Scler. 2018; 24(5): 579–586.
  32. Shirani A, Zhao Y, Kingwell E, et al. Temporal trends of disability progression in multiple sclerosis: findings from British Columbia, Canada (1975-2009). Mult Scler. 2012; 18(4): 442–450.
  33. Gharagozli K, Poorsaadat L, Harandi AA, et al. Frequency distribution of the first clinical symptoms in the Iranian population with multiple sclerosis. Iran J Neurol. 2012; 11(3): 118–120.
  34. Alla S, Pearson JF, Taylor BV, et al. Disability profile of multiple sclerosis in New Zealand. J Clin Neurosci. 2016; 28: 97–101.
  35. Patti F, Vila C. Symptoms, prevalence and impact of multiple sclerosis in younger patients: a multinational survey. Neuroepidemiology. 2014; 42(4): 211–218.
  36. Siva A. Asymptomatic MS. Clin Neurol Neurosurg. 2013; 115 Suppl 1: S1–S5.
  37. Cortese M, Riise T, Bjørnevik K, et al. Preclinical disease activity in multiple sclerosis: A prospective study of cognitive performance prior to first symptom. Ann Neurol. 2016; 80(4): 616–624.
  38. Bernitsas E, Khan O, Razmjou S, et al. Cerebrospinal fluid humoral immunity in the differential diagnosis of multiple sclerosis. PLoS One. 2017; 12(7): e0181431.
  39. Kinoshita M, Daifu M, Tanaka K, et al. Prognostic value of oligoclonal IgG bands in Japanese clinically isolated syndrome converting to clinically definite multiple sclerosis. J Neuroimmunol. 2017; 307: 1–6.
  40. Martinelli V, Dalla Costa G, Messina MJ, et al. Multiple biomarkers improve the prediction of multiple sclerosis in clinically isolated syndromes. Acta Neurol Scand. 2017; 136(5): 454–461.
  41. Farina G, Magliozzi R, Pitteri M, et al. Increased cortical lesion load and intrathecal inflammation is associated with oligoclonal bands in multiple sclerosis patients: a combined CSF and MRI study. J Neuroinflammation. 2017; 14(1): 40.
  42. Ferraro D, Franciotta D, Bedin R, et al. RIREMS group (Rising Italian Researchers in Multiple Sclerosis). A multicenter study on the diagnostic significance of a single cerebrospinal fluid IgG band. J Neurol. 2017; 264(5): 973–978.
  43. Schwenkenbecher P, Sarikidi A, Wurster U, et al. McDonald Criteria 2010 and 2005 Compared: Persistence of High Oligoclonal Band Prevalence Despite Almost Doubled Diagnostic Sensitivity. Int J Mol Sci. 2016; 17(9).