Prognosis

The prognosis for multiple sclerosis is very variable.

After typically 10 to 20 years, a progressive clinical course develops in many of the persons affected, eventually leading to impaired mobility and cognition; approximately 15% of patients have a progressive course from onset (1).

• most patients (85%–90%) have a relapsing course from onset that is characterized by relapses and remissions of neurological symptoms associated with areas of CNS inflammation
  • over the course of two decades more than half of untreated patients transition to a phase of gradual worsening independent of acute attacks (secondary progressive MS)
• progressive forms of MS can be present as the initial disease course (primary progressive MS) in approximately 10%–15% of patients (2)

Prognosis is dependent on the (3):

• number of attacks - a high frequency of relapses in the first few years is a bad prognostic sign; the average relapse rate in first few years is approximately one per year
• type of attack:
  • primary symptoms of visual loss are associated with a better outlook
  • primary motor attacks, ataxia, or bulbar problems are associated with a poor prognosis

Clinical factors that have been associated with poorer prognosis include (3,4):

• MS in males
• older at age of onset of MS
• if MS has a multifocal presentation
• involvement of pyramidal and cerebellar systems.
• partial recovery from relapses.
• high frequency of relapses in the first few years
• higher lesion burden on magnetic resonance imaging.

Life expectancy:

• average life expectancy for people with MS is around 5 to 10 years lower than average, and this gap appears to be getting smaller all the time (5)

Reference:

• Reich DS et al. Multiple Sclerosis. N Engl J Med 2018;378:169-80.
• ECTRIMS/EAN guideline on the pharmacological treatment of people with multiple sclerosis.European Journal of Neurology 2018, 25: 215–237
• Confavreux et al. Relapses and progression of multiple sclerosis. NEJM 2000;343:1430-1438.
• NHS CKS. Multiple Sclerosis (Accessed 20/11/2020)
• NHS Sotland. Multiple Sclerosis (Accessed 20/11/2020)