The clinical course of MS is unpredictable. Neurologists are not able to foresee which newly diagnosed patients will have a benign course, who will have attacks, or who will gradually progress. Nonetheless, studies of large numbers of MS patients suggest that some disease-related factors do have some predictive value. The following factors are more likely to be associated with a favorable prognosis: (1) female gender, (2) age of disease onset earlier than 40 years, (3) a first attack consisting of optic neuritis or other sensory symptoms, (4) lack of significant disability 5 years after onset, and (4) minor abnormalities of brain MRI scan at the time of diagnosis. As a general rule, patients who have either difficulty walking or with sustained impairment in coordination after their first attack has resolved, and patients with a large number of MRI lesions have a less favorable prognosis.
Disability resulting from the first five years of the disease tends to predict the level of disability 15-20 years after diagnosis. Thus, it is often said that patients who have little or no disability five years after their diagnosis have the most favorable prognosis. Fifteen years after diagnosis, approximately 50% of patients will use a cane or other assistance to ambulate. Twenty years following diagnosis, approximately 60% of MS patients are still capable of ambulation, 20-30% maintain employment, and less than 15% require custodial care. Life span is shortened only slightly compared to the general population.
For the 1844 patients, median ages at time of assignment of irreversible disability were
44.3 years... for a score of DSS 4, (limited walking but without aid)
54.7 years….for DSS 6 (walking with unilateral aid)
63.1 years …for DSS 7 (wheelchair bound)
prognosis in multiple sclerosis appears, at least to some extent, as age-dependent and not substantially affected by the initial course, be it exacerbating-remitting or progressive.
For the entire cohort, median times to reach Disability Status Scale (DSS) 6, 8 and 10 were 12.7, 20.6 and 43.9 years, respectively.
These findings demonstrate that among SAP patients, the degree of recovery from the single defining exacerbation had no significant effect on outcome.
The site of the original attack was not usually where progression began.
The relatively stereotyped nature of the progressive phase seen in all progressive phenotypes suggests regional and/or functional differential susceptibility to a process that appears degenerative in nature.
The highly prevalent distal corticospinal tract dysfunction in progressive disease and the pathologically demonstrated selective axonal loss seen in this tract raises the possibility of a dying back central axonopathy, at least in part independent of plaque location or burden.
SUMMARY: Overall course and prognosis in multiple sclerosis is most likely to be related to age and the occurrence of the progressive phase of the disease, rather than to relapses or other clinical parameters. Individual prognosis remains hazardous.
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