|
|
| Line 13: |
Line 13: |
| == Prognosis == | | == Prognosis == |
|
| |
|
| The [[prognosis]] (the expected future course of the disease) for a person with multiple sclerosis depends on the subtype of the disease; the individual's sex, race, age, and initial symptoms; and the degree of disability the person experiences. The [[life expectancy]] of people with MS is now nearly the same as that of unaffected people. This is due mainly to improved methods of limiting disability, such as [[physical therapy]], [[occupational therapy]] and [[speech therapy]], along with more successful treatment of common complications of disability, such as [[pneumonia]] and [[urinary tract infection]]s.<ref>Weinshenker BG.''Natural history of multiple sclerosis.'' Ann Neurol 1994;36 Suppl:S6–11. PMID 8017890</ref> Nevertheless half of the deaths in people with MS are directly related to the consequences of the disease, while 15% more are due to suicide.<ref>{{cite journal|author=Stern M |title=Aging with multiple sclerosis |journal=Physical medicine and rehabilitation clinics of North America|volume=16 |issue=1 |pages=219-34 |year=2005 |pmid=15561552}}</ref>
| | there are some factors associated with a particularly poor prognosis among patients with multiple sclerosis although We can’t surly say what is the prognosis of MS patients. |
|
| |
|
| * Individuals with progressive subtypes of MS, particularly the primary progressive subtype, have a more rapid decline in function. In the primary progressive subtype, supportive equipment (such as a [[wheelchair]] or [[standing frame]]) is often needed after six to seven years. However, when the initial disease course is the relapsing-remitting subtype, the average time until such equipment is needed is twenty years. This means that many individuals with MS will never need a wheelchair. There is also more cognitive impairment in the progressive forms than in the relapsing-remitting course.
| | '''Relapsing versus progressive disease''' |
| * The earlier in life MS occurs, the slower [[disability]] progresses. Individuals who are older than fifty when diagnosed are more likely to experience a chronic progressive course, with more rapid progression of disability. Those diagnosed before age 35 have the best prognosis. Females generally have a better prognosis than males. Although individuals of African descent tend to develop MS less frequently, they are often older at the time of onset and may have a worse prognosis.
| |
| * Initial MS symptoms of visual loss or sensory problems, such as [[numbness]] or [[tingling]], are markers for a relatively good [[prognosis]], whereas [[gait disturbance|difficulty walking]] and [[weakness (medical)|weakness]] are markers for a relatively poor prognosis. Better outcomes are also associated with the presence of only a single symptom at onset, the rapid development of initial symptoms, and the rapid regression of initial symptoms.
| |
| * The degree of disability varies among individuals with MS. In general, one of three individuals will still be able to work after 15–20 years. Fifteen percent of people diagnosed with MS never have a second relapse, and these people have minimal or no disability after ten years.<ref>Pittock SJ; McClelland RL; Mayr WT; Jorgensen NW; Weinshenker BG; Noseworthy J; Rodriguez M.''Clinical implications of benign multiple sclerosis: a 20-year population-based follow-up study'' Ann Neurol 2004 Aug;56(2):303-6.PMID 15293286</ref> The degree of disability after five years correlates well with the degree of disability after fifteen years. This means that two-thirds of people with MS with low disability after five years will not get much worse during the next ten years. It should be noted that most of these outcomes were observed before the use of medications such as interferon, which can delay disease progression for several years.
| |
|
| |
|
| Currently there are no clinically established laboratory investigations available that can predict prognosis or response to treatment. However, several promising approaches have been proposed. These include measurement of the two [[antibody|antibodies]], [[myelin oligodendrocyte glycoprotein|anti-myelin oligodendrocyte glycoprotein]] and [[myelin basic protein|anti-myelin basic protein]], and measurement of TRAIL ([[TNF]]-related [[apoptosis]]-inducing [[ligand]]).<ref>Berger T, Rubner P, Schautzer F, Egg R, Ulmer H, Mayringer I, Dilitz E, Deisenhammer F, Reindl M. ''Antimyelin antibodies as a predictor of clinically definite multiple sclerosis after a first demyelinating event.'' N Engl J Med. 2003 Jul 10;349(2):139-45. PMID 12853586</ref>
| | Progressive form of MS seems to have worse prognosis in comparison to relapsing remitting form of MS. Disabilities start sooner in progressive form (3_15_13) but some studies showed that age of onset is more important in MS disability than the form of the disease (18_47) |
| | |
| | '''Early symptoms''' |
| | |
| | Some first manifestations of MS disease like bowel and bladder dysfunction, seems to have a worse prognosis (48). Another study demonstrated that having so many symptoms at the onset of the disease have a worse prognosis than being monosymptom.(8) |
| | |
| | '''Demographics''' |
| | |
| | Onset of MS in Black Americans is in later age and they are more susceptile of having multifocal signs and symptoms and involvement of optic nerve and spinal cord.(58) |
| | |
| | '''Sex''' |
| | |
| | Women seems to have younger age of onset and so better prognosis than men.(3) |
| | |
| | '''Smoking''' |
| | |
| | Transition of RRMS to SPMS can be accelerated with smoking.(60) |
|
| |
|
| ==References== | | ==References== |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Please help WikiDoc by adding more content here. It's easy! Click here to learn about editing.
Overview
Natural History
Complications
Prognosis
there are some factors associated with a particularly poor prognosis among patients with multiple sclerosis although We can’t surly say what is the prognosis of MS patients.
Relapsing versus progressive disease
Progressive form of MS seems to have worse prognosis in comparison to relapsing remitting form of MS. Disabilities start sooner in progressive form (3_15_13) but some studies showed that age of onset is more important in MS disability than the form of the disease (18_47)
Early symptoms
Some first manifestations of MS disease like bowel and bladder dysfunction, seems to have a worse prognosis (48). Another study demonstrated that having so many symptoms at the onset of the disease have a worse prognosis than being monosymptom.(8)
Demographics
Onset of MS in Black Americans is in later age and they are more susceptile of having multifocal signs and symptoms and involvement of optic nerve and spinal cord.(58)
Sex
Women seems to have younger age of onset and so better prognosis than men.(3)
Smoking
Transition of RRMS to SPMS can be accelerated with smoking.(60)
References
Template:WH
Template:WS