Prognosis in multiple sclerosis

Abstract

Multiple sclerosis (MS) is an inflammatory demyelinating disease with an extremely variable clinical course and prognosis. The problem of prognosis exists ever since the first diagnosis of MS had been established. A broad spectrum of different clinical and non-clinical features has been analysed up to now, with respect to their validity in assessing long-term prognosis in MS. Most investigators agree that male sex, higher age at onset, pyramidal, cerebellar, or sphincteric disturbances at onset and chronic progressive disease course (primary-progressive or secondary progressive) are related to the poor prognosis, whereas female sex, onset at a younger age, sensory symptoms at onset, as well as relapsing-remitting disease course, indicate the better disease outcome. The prognostic significance of other demographic, clinical, paraclinical features, personal or familial history data, genetic and environmental factors, is still a matter of controversy and is to be elucidated in future studies. Studies on natural course and prognosis should meet the criterion of completeness in all its senses, be prospective with a long-term follow-up, and be briefly designed in order to avoid the possible bias influences.