The Prognosis of Early MS
A commonly asked question from an individual diagnosed with Multiple Sclerosis (MS) is, “What is going to happen to me?” The enormous range of symptoms and disability among MS patients makes it challenging to provide more than a general prognosis. For any one person, it is not possible to determine—even early in the course of the disease— how benign or severe the disease will be.
Following an MS diagnosis, favorable prognostic factors include:
- being Caucasian
- being female
- a younger age at disease onset
- sensory symptoms at onset
- full recovery from the initial attack
- fewer relapses in the years after diagnosis
- fewer lesions on the baseline MRI
However, these are generalizations and can only give a rough estimate of disease severity over time. Each individual case follows its own unique course. As with all generalizations, what is typically held to be true cannot be applied to all individuals, as for example the statement that men are generally taller than women, which is certainly not always the case.
The same is true with MS. I know young, white females who have had a very difficult time with MS. I also know older African-American males who have no clinical evidence of the disease. Additionally, the above prognostic factors can sometimes be quite misleading. Even though younger patients generally have slower progression of their symptoms, they are going to live longer with the illness and will have more years to accumulate disability.
If I could add any tool to my treatment arsenal for patients with MS, it would be a crystal ball. There is a small subset of patients with MS who are destined to have mild disease even without treatment. At present, we cannot predict who those patients are, however. As a result, most practitioners, including myself, suggest the initiation of early treatment, even in those patients who do not meet the formal criteria for MS. When these patients do well, we can never know for certain if it is because the medication is working or because they were destined from the start to a mild disease course.
Unfortunately, there are also patients who are going to have a severe disease, and we cannot predict who these patients will be early in the disease course. Several years ago, when there were fewer treatments available to patients, predicting a patient's clinical course would have limited value. However, with the release of more powerful medicines to treat MS, such as Tysabri and Gilenya, the issue of prognosis has grown in importance. Hopefully, future research will provide doctors with better tools to give more accurate prognoses of MS. The hope is that doctors will be able to recognize which patients should be started on aggressive therapy from day one, and which patients might never need therapy at all.