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.
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!).
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.
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.
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.
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:
2. The National Multiple Sclerosis Society
3. The University of California – San Francisco Multiple Sclerosis Center
4. The Multiple Sclerosis International Federation
The illustration above is from Joseph Babinski’s 1885 thesis, “Etude anatomique et clinique de la sclÃ©rose en plaques.”
Tagsacute leukemia acute lymphoblastic leukemia acute myeloid leukemia acute promyelocytic leukemia Add new tag anemia b cells blood smear bone marrow brain tumors carcinoma cases chronic myelofibrosis chronic myeloid leukemia chronic myeloproliferative disorders coagulation cortisol cytochemistry cytogenetics essential thrombocythemia heart hemophilia immunology infection inflammation kaplan kidney laboratory tests lymphocyte lymphocytes lymphoma macrophages neoplasia neutrophil normal photoblog polycythemia vera red blood cells red cells sickle cell anemia skin squamous cell carcinoma stains student questions t cells
- Ephriam Bam said Thanks very much for your simple and clear explanation!
- Marina P said Professor Thomas Renne from Sweden and his group conduct research on the topic of FXII, I found it m...
- sachini said Very important this one.thank you
- Jeevanshu Dhawan said That is the most simple explanation I have read till date. Thanks.
- pooja said Great explanation. Thank you
- Sandhya said Kristine, you are a teacher non-pareil !
- Lilah said Thanks looking forward for the bites
- Kristine said Hi Kanopo – it’s okay! Leukemias and lymphomas can be confusing, for sure. To answer you...
- Kristine said There are a million microliters in a liter (1 L = 1,000,000 microliters). So 4,000 cells/microliter...
- VAISHALI said STILL I DONT UNDERSTAND-LOWER NORMAL RANGE IS 4.0 x 103/μL THAT MEANS IN 1uL THERE ARE 4000 CELLS,SO...
- Devender Singh said good
- LILAH said SOOO GOOD