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Cognitive impairment is increasingly recognized as a significant manifestation of multiple sclerosis (MS) and an impediment to patient quality of life. Now evidence presented by Portaccio et al.1 in this issue of Neurology® suggests that absence of cognitive impairment may also be an important predictor for benign MS (BMS). To date BMS defines a condition “in which the patient remains fully functional in all neurologic systems 15 years after disease onset” as indicated by an Expanded Disability Status Scale (EDSS) score ≤3.2 This label is given retrospectively and reflects primarily a low level of (motor) disability. More importantly, this definition does not preclude that some of these patients subsequently go on to enter a more active and disabling phase of their disease. Thus clinical features alone appear insufficient to define BMS.
Inclusion of imaging findings should be one step forward to better characterize BMS. It would be expected that BMS is associated with a lower rate of lesion accrual and less severe tissue damage within and outside lesions.3 Also lesion distribution such as relative …
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