Prognosis

Multiple Sclerosis is not considered a fatal condition however it is progressive and degenerative, particularly so if untreated or managed. Many people live long and relatively fulfilling with MS if managed well with changes to lifestyle and if available, treatment. Life expectancy for people with MS continues to increase which may be due to advances in treatment, diagnosis, and a better understanding of the impact of a health lifestyle. On average, a person with MS can expect to live 7-10 years fewer than those without MS. Most people find the condition to be very unpredictable with the type, frequency and severity of symptoms varying significantly from one person to another.

NZ MS Incidence Study

According to the 2012-14 NZ MS Incidence Study 88% of those are initially diagnosed with relapsing remitting MS and 12% with progressive MS. Up to 80% of people will eventually convert from relapsing remitting to secondary progressive MS during the course of their condition. Of the 277 participants who were originally recruited as clinically isolated syndrome (CIS – following their first attack or symptom presentation) 35% were subsequently diagnosed as having clinically definite MS during the study period.

Prognosis and Relapsing MS

For those with relapsing forms of MS there is no predictor as to the frequency or timing of relapses. In some cases people have been known to go for many years, or decades without new relapses. A relapse does not mean that your disability will progress as in most cases following a relapse and a period of recovery there will be no lasting damage. In some cases, depending on the severity and localisation of new brain lesions disability progression may occur. You should keep a record of any relapses and ensure that you discuss these with your health professional. Disease modifying treatments available in New Zealand, in most cases, effectively help to minimise the relapse rate and disability progression.
Currently in New Zealand disease modifying treatments (DMTs) are only available for those with relapsing remitting forms of MS. Where treatments aren’t available not wanted it is important to work with your health professionals and community supports and address lifestyle changes such as diet, sunlight, exercise, and meditation. Read more about available DMTs here.

Prognosis and Progressive MS

The nature of progressive MS means that disability will occur much faster however there is no definitive research to predict how this will occur and over what time period. According to a 2005 study a quarter participants with primary progressive MS required a walking cane within 7.5 years however a quarter still did not require one after 25 years. Research also shows that men tend to progress faster than women by 38%. Other studies have shown that from diagnosis to an EDSS score of 6, the median time for secondary progressive groups was 10 years, while it was just three years for the primary progressive group.

Factors Influencing Prognosis

Research suggests there are factors that may influence how MS may develop. These have been observed in long-term studies and reflect the trend associated with certain symptoms. They do not represent a guide as to how an individual’s MS will develop as the course of a person’s MS is unique.
Factors that are suggestive of a relatively better disease course are:

• diagnosed at a younger age, eg. in the 20’s or 30’s
• few relapses in the first few years after diagnosis
• complete recovery from relapses with no long-term damage
• long intervals between relapses
• symptoms that are sensory in nature (such as numbness or tingling).

It is generally recommended that the longer that you can maintain a healthy brain and lifestyle the better your prognosis.

Further information and acknowledgements

Prognosis – MS Trust
How does MS Progress – Overcoming MS
Multiple Sclerosis Prognosis and Life Expectancy – Multiple Sclerosis News Today
Is MS Fatal – National MS Society

Research into MS Prognosis

• Bronnum-Hansen H, Koch-Henriksen N, Stenager E. Trends in survival and cause of death in Danish patients with multiple sclerosis. Brain 2004; 11:11Vukusic S, Confavreux C. Natural history of multiple sclerosis: risk factors and prognostic indicators. Current Opinion in Neurology 2007;20(3):269-274.
• Confavreux C, Vukusic S. Natural history of multiple sclerosis: a unifying concept. Brain 2006
• Confavreux C, Vukusic S. Age at disability milestones in multiple sclerosis. Brain 2006
• Confavreux C, et al. Course and prognosis of multiple sclerosis assessed by the computerized data processing of 349 patients.Brain 1980;103(2):281-300. Kremenchutzky M, Rice GP, Baskerville J, et al. The natural history of multiple sclerosis: a geographically based study 9: Observations on the progressive phase of the disease. Brain 2006
• Hammond SR, McLeod JG, Macaskill P, et al. Multiple sclerosis in Australia: prognostic factors. J Clin Neurosci 2000; 7:16-19
• Pittock SJ, Mayr WT, McClelland RL, et al. Disability profile of MS did not change over 10 years in a population-based prevalence cohort. Neurology 2004; 62:601-606
• Tremlett H, Paty D, Devonshire V. The natural history of primary progressive MS in British Columbia, Canada. Neurology 2005; 65:1919-1923
• Tremlett H, Paty D, Devonshire V. Disability progression in multiple sclerosis is slower than previously reported. Neurology 2006; 66:172-177
• Neurologic Impairment 10 Years After Optic Neuritis. Arch Neurol 2004; 61:1386-1389