It is very difficult to prognosticate effectively for patients with MS. Some patients have a very benign course and/or respond well to treatment, whereas others become rapidly disabled within several years of diagnosis. One long-term follow-up study of a pivotal interferon beta-1b trial in patients with MS suggested that long-term physical and cognitive outcomes may be largely determined early in the disease course.[189]Goodin DS, Traboulsee A, Knappertz V, et al. Relationship between early clinical characteristics and long term disability outcomes: 16 year cohort study (follow-up) of the pivotal interferon beta-1b trial in multiple sclerosis. J Neurol Neurosurg Psychiatry. 2012 Mar;83(3):282-7.
https://jnnp.bmj.com/content/83/3/282.full
http://www.ncbi.nlm.nih.gov/pubmed/22193561?tool=bestpractice.com
Various factors favouring better prognosis have been reported in demographic studies conducted in the pre-treatment era, and include include female sex, sensory symptoms, or optic neuritis at onset.[190]Hawkins SA, McDonnell GV. Benign multiple sclerosis? Clinical course, long term follow up, and assessment of prognostic factors. J Neurol Neurosurg Psychiatry. 1999 Aug;67(2):148-52.
https://jnnp.bmj.com/content/67/2/148.long
http://www.ncbi.nlm.nih.gov/pubmed/10406979?tool=bestpractice.com
Poorer prognostic factors include frequent relapses and motor or cerebellar onset.[191]Damasceno A, Von Glehn F, Brandão CO, et al. Prognostic indicators for long-term disability in multiple sclerosis patients. J Neurol Sci. 2013 Jan 15;324(1-2):29-33.
http://www.ncbi.nlm.nih.gov/pubmed/23073568?tool=bestpractice.com
[192]Zaffaroni M, Ghezzi A. The prognostic value of age, gender, pregnancy and endocrine factors in multiple sclerosis. Neurol Sci. 2000;21(4 suppl 2):S857-60.
http://www.ncbi.nlm.nih.gov/pubmed/11205363?tool=bestpractice.com
Magnetic resonance imaging (MRI) is a useful tool to assist in prognosis; e.g., to predict MS development, disability, and disability progression.[3]Wattjes MP, Ciccarelli O, Reich DS, et al. 2021 MAGNIMS-CMSC-NAIMS consensus recommendations on the use of MRI in patients with multiple sclerosis. Lancet Neurol. 2021 Aug;20(8):653-670.
https://www.doi.org/10.1016/S1474-4422(21)00095-8
http://www.ncbi.nlm.nih.gov/pubmed/34139157?tool=bestpractice.com
Higher MRI lesion burden at onset may portend a poorer prognosis, particularly for cognitive outcomes.[189]Goodin DS, Traboulsee A, Knappertz V, et al. Relationship between early clinical characteristics and long term disability outcomes: 16 year cohort study (follow-up) of the pivotal interferon beta-1b trial in multiple sclerosis. J Neurol Neurosurg Psychiatry. 2012 Mar;83(3):282-7.
https://jnnp.bmj.com/content/83/3/282.full
http://www.ncbi.nlm.nih.gov/pubmed/22193561?tool=bestpractice.com
[193]Vukusic S, Confavreux C. Natural history of multiple sclerosis: risk factors and prognostic indicators. Curr Opin Neurol. 2007 Jun;20(3):269-74.
http://www.ncbi.nlm.nih.gov/pubmed/17495619?tool=bestpractice.com