Health-related quality of life in clinically isolated syndrome and risk of conversion to multiple sclerosis


Background and objectives

A few studies have found that low scores on self-rated health and quality of life measures are associated with following worsening disability in multiple sclerosis (MS). We wanted to estimate the association between self-rated quality of life scores among patients with clinically isolated syndrome (CIS) and the risk of subsequent conversion to definite MS.


One hundred sixty-two patients from the GERONIMUS cohort with a symptom or sign suggestive of MS and without a definite diagnosis of MS at the time of inclusion were asked to evaluate their health-related quality of life according to MSQoL-54 scale. They were clinically assessed and mood and depression scales were applied. The association between the scores of these scales and the risk of converting to definite MS during a 5-year follow-up was estimated using the Cox- proportional hazard regression model.


Quality of life at examination was significantly lower compared to those of an age- and sex-adjusted general Italian population. During the follow-up, 116 patients (72%) converted to definite MS. No significant predictive effects were found for the summary scales of MSQol-54 or other scales. The estimates did not change after adjusting for age, sex, BMI, education, MRI findings, Expanded Disability Status Scale (EDSS) score, and treatment at time of examination.


Persons with CIS in this cohort reported reduced self-rated quality of life compared to the general population, but variation in these scores was not associated with subsequent conversion from CIS to clinical definite MS.

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The authors thank all patients and clinical researchers who contributed to the G.E.Ro.N.I.Mu.S study. We are indebted to Eleonora Romagnoli, Silvia Canala, and the YGHEA staff for their precious technical assistance. Members of the G.E.Ro.N.I.Mu.S. study group are as follows: Marianna Pattini, MD (Centro Sclerosi Multipla, U.O di Neurologia, Ospedale Civile –Localita’ Vaio, Site investigators); Erica Curti, MD, Elena Tsantes, MD (Centro Sclerosi Multipla Dipartimento di Neuroscienze,Universita` di Parma, site investigator); Enrico Montanari, MD; Angelica Guaresci,MD (Centro Sclerosi Multipla, Ospedale di Fidenza, Parma, site investigator); Concetta Feo (U.O.S Neurofisiologia, U.O. Neurologia, Ospedale Santa Maria Nuova, Reggio Emilia, site investigator); Sergio Stecchi, MD; Lucia La Mola; Renzo Balugani (UO Riabilitazione-Sclerosi Multipla, IRCCS Istituto delle Scienze Neurologiche, Bologna, site investigators); Fabio Pizza, MD (Dipartimento di Scienze Neurologiche, Universita’ di Bologna, site investigator); Laura Delaj, MD; Silvia De Pasqua, MD; Rita Rinaldi, MD (U.O Neurologia, Dipartimento Neuro-Senso-Motorio, Policlinico S.Orsola-Malpighi, Bologna, site investigators); Eleonora Baldi, MD, Luisa Caniatti, MD, Paola Milani, Psychologist (Dipartimento di Neuroscienze,Azienda Ospedaliero Universitaria S. Anna, Ferrara, site investigators and psychologic testing); Vittoria Mussuto, MD; Monica Manzoni, Psycologist (U.O. Neurologia, Ospedale Santa Maria della Scaletta, Imola, site investigators); Mario Casmiro, MD; Claudia Guerrini (Ospedale per gli Infermi,AUSL Ravenna, Faenza, site investigators); Laura Mambelli (U.O. di Neurologia, Presidio Ospedaliero G.B. Morgagni-L. Pierantoni, Forlı`, site investigator); Paola Naldi, MD; Laura Collimedaglia, Domizia Vecchio (SCDU Neurologia, A.O.U. “Maggiore della Carita`”, Novara, site investigators); Erika Pietrolongo, PhD; Valeria Di Tommaso, MD; Giovanna DeLuca, MD; Daniela Travaglini, MD (Centro Sclerosi Multipla, Clinica Neurologica, Dipartimento di Neuroscienze e Imaging, Universita` “G. d’Annunzio”, Chieti, site investigators and psychological testing); Maria Donata Benedetti, MD; Francesca Rossi, MD (Neurologia B - Policlinico Borgo Roma AOUI Verona, site investigators); Marco Pastore Trossello, MD; Luca Faccioli, MD; Luca Spinardi, MD (SSD Neuroradiologia, AOSP, Bologna, MRI review).


This study was supported with an unconditional grant by Biogen Idec and by the Department of Neurological Sciences of the University of Bologna. None of the authors received fees for the participation to the study.

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Correspondence to Roberto D’Alessandro.

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Conflicts of interest

A. Gajofatto reports personal fees and grants from MERCK, non-financial support from NOVARTIS. F. Granella reports grants, personal fees, and non-financial support from Biogen, personal fees and non-financial support from Sanofi Genzyme, Novartis, Merck, and non-financial support from Almirall. M. Leone reports grants from TEVA. A. Lugaresi reports grants and personal fees from Bayer, Biogen, Merck, Novartis, Sanofi- Genzyme, Teva, and Almirall. S. Malagù reports non-financial support from Biogen, Sanofy-Aventis, personal fees and non-financial support from Merck-Serono, personal fees from Bayer, Novartis. E. Baldin, R. D’Alessandro, K. Mattarozzi, L. Motti, W. Neri, I. Pesci, T. Riise, M. Santangelo, C. Scandellari, M.R. Tola, L. Vignatelli, and C. Zenesini have no conflicts of interest to disclose.

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Baldin, E., Riise, T., Mattarozzi, K. et al. Health-related quality of life in clinically isolated syndrome and risk of conversion to multiple sclerosis. Neurol Sci 40, 75–80 (2019).

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  • Clinically isolated syndrome (CIS)
  • Multiple sclerosis
  • Prognostic factors
  • Prospective study
  • Quality of life
  • Self-rated health