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From the Corinne Goldsmith Dickinson Center for Multiple Sclerosis (Dr. Lublin), Mount Sinai Medical Center, New York, NY; Cooper Institute (Dr. Baier), Denver, CO; and University of Nevada, Reno, and Pythagoras, Inc. (Dr. Cutter).
Address correspondence and reprint requests to Dr. F.D. Lublin, Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai Medical Center, 5 E. 98 St., New York, NY 10029; e-mail: fred.lublin{at}mssm.edu
Objective: To determine the percentage of patients with residual deficits following multiple sclerosis (MS) exacerbations and the magnitude of those deficits using a database of pooled placebo patients from clinical trials.
Methods: A database of patients assigned to the placebo group in several randomized clinical trials was queried to determine those patients with Expanded Disability Status Scale (EDSS) and Scripps Neurologic Rating Scale assessments prior to, at the time of, and after an acute exacerbation of MS. The extent of deficit present at these time points was compared to determine the acute effect of exacerbations and the degree of persistent disability.
Results: Forty-two percent of patients had residual deficit of at least 0.5 and 28% had residual of 
1.0 EDSS units, at an average of 64 days after an exacerbation. The results were reproduced across subsequent exacerbations and were sustained over time. The subgroup of patients with measurable change in EDSS during the exacerbation had more extensive residual impairment on the follow-up visits. Similar results were seen when the Scripps score was examined.
Conclusion: MS exacerbations produce a measurable and sustained effect on disability.
Received March 21, 2002. Accepted in final form August 18, 2003.
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