What's prognosis of multiple sclerosis?

Less than 5% of people with multiple sclerosis have a severe progressive form, leading to death from complications within five years. At the other extreme, 10-20% have a benign form, with a very slow or no progression of their symptoms. The most recent studies show that about seven out of 10 people with multiple sclerosis are still alive 25 years after their diagnosis, compared to about nine out of 10 people of similar age without disease. On average, multiple sclerosis shortens the lives of affected women by about six years, and men by 11 years. Suicide is a significant cause of death in multiple sclerosis, especially in younger patients. The degree of disability a person experiences five years after onset is, on average, about three-quarters of the expected disability at 10–15 years. A benign course for the first five years usually indicates the disease will not cause marked disability.

Because of improved treatment for complications such as lung and bladder infections, the life expectancy of those diagnosed with multiple sclerosis is only slightly reduced. The earlier in life disease onset occurs, the slower disability progresses. This is due to more frequent chronic progressive courses with faster accumulation of disability when onset occurs at a higher age. Disability after 5 years correlates well with disability after 15 years: 2/3 of multiple sclerosis patients with low disability after 5 years will not markedly deteriorate during the next ten years. Further multiple sclerosis cases in the family do not influence disease progression. 1 of 3 patients will still be able to work after 15-20 years. Visual loss as the initial symptom is a marker for a rather good prognosis; gait disturbance, weakness or numbness for a rather poor prognosis. Rapid regression of initial symptoms, age at onset below 35, only a single symptom at onset, rapid development of initial symptoms and short duration of the last relapse indicate a good prognosis. When the initial disease course is relapsing remitting, the statistical duration until a wheelchair is needed, is 20 years. This means that many multiple sclerosis patients will never need a wheelchair. If the disease course is primary progressive then a wheelchair at an average will be needed after 6 to 7 years. It has to be noted that most of this longterm data was acquired before the advent of modern immunomodulatory drugs about 10 years ago, which have been shown to delay disease progression over a period of several years.

Currently there are no clinically established laboratory investigations available to predict prognosis or therapeutic response, although promising approaches have been undertaken that need further confirmation, such as determination of the two antibodies anti-MOG and anti-MBP or of TRAIL (TNF-Related Apoptosis Inducing Ligand).

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