MS 644x1024 What is the prognosis in multiple sclerosis?

Q. My 28 year old friend was just diagnosed with multiple sclerosis. What can he expect regarding prognosis?

A. MS is a demyelinating disease that is thought to be autoimmune in nature. It is not easy to predict an exact prognosis for an individual patient, but I think you can boil it down to the fact that while a small number of people with MS become unable to write, speak, or walk, the vast majority of patients are mildly affected by their disease. Let’s look at this in a little more detail.

Subtypes

There are several subtypes of MS, each with different symptoms and prognoses. Note that the frequencies of the different subtypes listed in different sources may not be comparable, because some sources refer to the frequency at diagnosis, while others refer to an overall frequency. It would be useful to know which subtype your friend fits into, because that may help determine his prognosis.

1. Benign MS
People with this type of MS have only rare attacks, and are minimally disabled 10 years after their diagnosis (therefore, you can’t make this diagnosis until 10 years have elapsed!).

2. Relapsing-Remitting
People with this type of MS attacks followed by partial or complete recovery periods free of disease progression. This is the most common type at diagnosis – but some patients move into one of the other types later on.

2. Primary-Progressive
People with this type of MS experience a slow but nearly continuous worsening of their disease from the onset, with no distinct relapses or remissions. This is an uncommon subtype.

3. Secondary-Progressive
People with this type of MS experience an initial period of relapsing-remitting MS, followed by a steadily worsening disease course. Many people with relapsing-remitting MS developed this form later on – but that was before new drugs for MS were introduced. This subtype may be less frequent now.

4. Progressive-Relapsing
People with this type of MS experience a steadily worsening disease from the onset but also have relapses, with or without recovery. In contrast to relapsing-remitting MS, the periods between relapses are characterized by continuing disease progression. This is an uncommon subtype.

Factors influencing prognosis

1. Factors associated with a better prognosis:

  • female gender
  • age of disease onset earlier than 40 years
  • a first attack consisting of optic neuritis or other sensory symptoms
  • lack of significant disability 5 years after onset
  • minor abnormalities on brain MRI scan at the time of diagnosis.

2. Factors associated with a less favorable prognosis:

  • male gender
  • age of onset at age 40 or later
  • a first attack consisting only of motor symptoms
  • difficulty walking or sustained impairment in coordination after resolution of first attack
  • large number of MRI lesions

All that being said…

It’s going to be hard to tell with a lot of certainty at this point what your friend’s prognosis is, because the diagnosis is new. Once he has had the disease a few years, then it will be important to see how it has progressed (or not progressed), because one of the more important predictors of one’s future MS course is one’s past MS course.

Here are some good web resources for learning more about MS:

1. The NIH
http://www.ninds.nih.gov/disorders/multiple_sclerosis/multiple_sclerosis.htm

2. The National Multiple Sclerosis Society
http://www.nationalmssociety.org/index.aspx

3. The University of California – San Francisco Multiple Sclerosis Center
http://www.ucsf.edu/msc/faq.htm#beyond

4. The Multiple Sclerosis International Federation
http://www.msif.org/en/about_ms/types_of_ms.html

The illustration above is from Joseph Babinski’s 1885 thesis, “Etude anatomique et clinique de la sclérose en plaques.”

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