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)