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MS information for health and social care professionals Prognosis

One of the chief characteristics of MS is its unpredictability from one person to another, from one day to another, from one time of day to another. However, some prognostications can be made from the pattern of the disease over the first 5 years. For example, early problems with sensation and eyesight (as opposed to problems related to the cerebellum, i.e. unsteadiness and clumsiness) usually indicate a more benign form of MS. Younger age at onset is also a good prognostic sign.

Factors that influence prognosis

Favourable

  • Females
  • Low rate of relapses per year
  • Complete recovery from the first attack
  • Long interval between first and second attack
  • Symptoms predominantly sensory
  • Younger age of onset
  • Low disability at 5 years from onset
  • Later cerebellar involvement
  • Involvement of only one CNS system at the time of onset

Unfavourable

  • Males
  • High rate of relapses per year
  • Incomplete recovery from the first attack
  • Short interval between first and second attack
  • Symptoms predominantly of motor tract involvement
  • Older age of onset
  • Significant disability at 5 years onset
  • Early cerebellar involvement
  • Involvement of more than one CNS system at the time of onset

Eventually it may be possible to predict the course of the disease more accurately with magnetic resonance imaging (MRI), but at present accurate prediction cannot be made.

It is not known whether there is any difference in longevity in the population of people with MS compared with the rest of the population[1]. The disease varies widely from person to person and life expectancy also varies widely, but seems to be close to normal for most, except those with unusually aggressive disease. Some of the most common causes of death in people with MS are secondary complications resulting from immobility, chronic urinary tract infections, and compromised swallowing and breathing.

Frequency of death by suicide has been found to be 7.5 times higher among patients with MS compared to the general population[2]. It was found that in suicidal patients, suicide rate did not correlate with disability.

The uncertainty of prognosis is hard to deal with. Many people ask if there is any way of identifying 'triggers' which will cause the condition to worsen but there is very little proof that any particular event or circumstance can be identified. There is some evidence that stressful life events, such as a car accident or severe emotional stress, can make deterioration more likely. However even this is controversial and there is usually little that can be done to prevent such stresses occurring.

Sometimes increased temperature, either from a hot climate or due to infection, can worsen symptoms and can occasionally cause a relapse. Not everyone is prone to this problem but those who are should try to reduce body temperature by such means as cooling or by taking aspirin at times of infection.

There is no known reason why someone with MS should avoid either immunisation or a necessary surgical operation. NICE guidance recommends people with MS should be offered immunisation against influenza and have any other immunisations and surgery that they need. There is no known risk of bringing about a relapse from prescribed medication.

References

  1. Bronnum-Hansen H, Koch-Henriksen N, Stenager E. Trends in survival and cause of death in Danish patients with multiple sclerosis. Brain 2004;127(4):844-50.
  2. Sadovnick AD, Eisen K, Ebers GC et al. Cause of death in patients attending multiple sclerosis clinics. Neurology 1991;41:1193-96.