prognosis

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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)

Last edited 11/2020 and last reviewed 11/2020

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