Recently, there has been speculation that disability in MS patients will be predictably present after several years of illness. Some have claimed that there is no difference between various patient groups and that disability eventuates in the majority of patients. Apart from this rhetoric, it is clear that the rate of progression in the early years of illness is in part related to the number of relapses in early illness. The Canadian observation that a single relapse in the first year of ill ness is a good prognostic sign is one that the majority of neurologists who are experienced in the care of MS share. In the "population studies" in southern Ontario, three attacks in the first year of illness led to wheelchair dependence within 5 years in half of those patients. This is in agreement with the clinical observation that an unusually large number of MS attacks in a short time period predict unusually severe disease.
Genetic studies have shown that patients with aggressive disease are genetically distinguished by the presence of two genes: HLA-B7 and DR-2 (DR-1 1501).
Recent studies of large numbers of patients in Europe, followed and documented for decades, have produced "new" data. These data from Europe indicate that 30% of patients will develop progressive disease rather than a larger estimate from centers here in the United States. It is important to bear in mind that these observations are based primarily on "untreated" MS patients. That is to say, the patients had not benefited from drugs that have been proven to reduce attacks of MS and to reduce the risk of disability.
Large numbers of neurologists interested in MS in the United States, Canada, and Europe have come to the same conclusions regarding the prognosis of MS:
1. Women with MS do better than men!
2. The onset of MS before the age of 30 is associated with a better prognosis.
3. One attack of MS, only, in the first year of illness predicts less disability.
4. Optic neuritis or retrobulbar neuritis as an initial attack has been recognized as being associated with a good prognosis.
5. A low lesion load (numbers of lesions and/or lesion volume) on the MRI has been interpreted as being associated with a better outlook.
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