Multiple sclerosis natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.


Multiple sclerosis usually start between age of fifteen to forty years, rarely before age fifteen or after age sixty with symptoms such as optic neuritis, diplopia, sensory or motor loss, vertigo and balance problems. It may be classified into four groups according to clinical course of the disease including relapsing-remitting, secondary-progressive, primary-progressive, and progressive-relapsing. Complications that can develop as a result of multiple sclerosis are: medication complication, Fatigue, mood problems, Spasticity, Bowel and bladder dysfunction, Cognitive impairment, Heat sensitivity., Incoordination, Pain, Sexual dysfunction, Sleep disorders, vertigo, visual loss. there are some factors associated with a particularly poor prognosis among patients with multiple sclerosis such as: Relapsing versus progressive disease, early symptoms, Demographics, Sex, Smoking.

Natural History, Complications, and Prognosis

Natural History


Complications that can develop as a result of mutiple sclerosis include:

  • Fatigue: Fatigue is seen in almost 80% of MS patients. They commonly feel exhausted and out of energy. We can see fatigue exacerbation before acute attacks in MS and for a while after that.[18]
  • Vertigo: Benign positional paroxysmal vertigo is the most common cause of vertigo in an MS patient. In the course of the disease about 30-50% of patients experience this symptom.[15]


There are some factors associated with a particularly poor prognosis among patients with multiple sclerosis. However, we can’t surly say what is the prognosis of MS patients.[30]

  • Smoking: Transition of RRMS to SPMS can be accelerated with smoking.[39]
  • Lipid specific immunoglobulin level: Lipid specific immunoglobulin level in CSF can predict long term outcomes of MS disease.[40]


  1. Weinshenker BG, Bass B, Rice GP, Noseworthy J, Carriere W, Baskerville J, Ebers GC (February 1989). "The natural history of multiple sclerosis: a geographically based study. I. Clinical course and disability". Brain. 112 ( Pt 1): 133–46. PMID 2917275.
  2. Lublin FD, Reingold SC (April 1996). "Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis". Neurology. 46 (4): 907–11. PMID 8780061.
  3. 3.0 3.1 Balcer LJ (March 2006). "Clinical practice. Optic neuritis". N. Engl. J. Med. 354 (12): 1273–80. doi:10.1056/NEJMcp053247. PMID 16554529.
  4. Čarnická Z, Kollár B, Šiarnik P, Krížová L, Klobučníková K, Turčáni P (April 2015). "Sleep disorders in patients with multiple sclerosis". J Clin Sleep Med. 11 (5): 553–7. doi:10.5664/jcsm.4702. PMC 4410929. PMID 25700869.
  5. 5.0 5.1 Sadovnick AD, Remick RA, Allen J, Swartz E, Yee IM, Eisen K, Farquhar R, Hashimoto SA, Hooge J, Kastrukoff LF, Morrison W, Nelson J, Oger J, Paty DW (March 1996). "Depression and multiple sclerosis". Neurology. 46 (3): 628–32. PMID 8618657.
  6. 6.0 6.1 Boissy AR, Cohen JA (September 2007). "Multiple sclerosis symptom management". Expert Rev Neurother. 7 (9): 1213–22. doi:10.1586/14737175.7.9.1213. PMID 17868019.
  7. 7.0 7.1 DasGupta R, Fowler CJ (2003). "Bladder, bowel and sexual dysfunction in multiple sclerosis: management strategies". Drugs. 63 (2): 153–66. PMID 12515563.
  8. 8.0 8.1 Achiron A, Barak Y (April 2003). "Cognitive impairment in probable multiple sclerosis". J. Neurol. Neurosurg. Psychiatry. 74 (4): 443–6. PMC 1738365. PMID 12640060.
  9. Frohman EM, Frohman TC, Zee DS, McColl R, Galetta S (February 2005). "The neuro-ophthalmology of multiple sclerosis". Lancet Neurol. 4 (2): 111–21. doi:10.1016/S1474-4422(05)00992-0. PMID 15664543.
  10. 10.0 10.1 Selhorst JB, Saul RF (June 1995). "Uhthoff and his symptom". J Neuroophthalmol. 15 (2): 63–9. PMID 7550931.
  11. 11.0 11.1 Rinker JR, Salter AR, Walker H, Amara A, Meador W, Cutter GR (January 2015). "Prevalence and characteristics of tremor in the NARCOMS multiple sclerosis registry: a cross-sectional survey". BMJ Open. 5 (1): e006714. doi:10.1136/bmjopen-2014-006714. PMC 4289717. PMID 25573524.
  12. 12.0 12.1 Drulovic J, Basic-Kes V, Grgic S, Vojinovic S, Dincic E, Toncev G, Kezic MG, Kisic-Tepavcevic D, Dujmovic I, Mesaros S, Miletic-Drakulic S, Pekmezovic T (August 2015). "The Prevalence of Pain in Adults with Multiple Sclerosis: A Multicenter Cross-Sectional Survey". Pain Med. 16 (8): 1597–602. doi:10.1111/pme.12731. PMID 26087108.
  13. 13.0 13.1 Lew-Starowicz M, Gianotten WL (2015). "Sexual dysfunction in patients with multiple sclerosis". Handb Clin Neurol. 130: 357–70. doi:10.1016/B978-0-444-63247-0.00020-1. PMID 26003254.
  14. 14.0 14.1 Manconi M, Rocca MA, Ferini-Strambi L, Tortorella P, Agosta F, Comi G, Filippi M (January 2008). "Restless legs syndrome is a common finding in multiple sclerosis and correlates with cervical cord damage". Mult. Scler. 14 (1): 86–93. doi:10.1177/1352458507080734. PMID 17942519.
  15. 15.0 15.1 Frohman EM, Zhang H, Dewey RB, Hawker KS, Racke MK, Frohman TC (November 2000). "Vertigo in MS: utility of positional and particle repositioning maneuvers". Neurology. 55 (10): 1566–9. PMID 11094117.
  16. Yamamoto T, Irisa T, Sugioka Y, Sueishi K (November 1997). "Effects of pulse methylprednisolone on bone and marrow tissues: corticosteroid-induced osteonecrosis in rabbits". Arthritis Rheum. 40 (11): 2055–64. doi:10.1002/1529-0131(199711)40:11<2055::AID-ART19>3.0.CO;2-E. PMID 9365096.
  17. Assouline-Dayan Y, Chang C, Greenspan A, Shoenfeld Y, Gershwin ME (October 2002). "Pathogenesis and natural history of osteonecrosis". Semin. Arthritis Rheum. 32 (2): 94–124. PMID 12430099.
  18. Krupp L (August 2006). "Fatigue is intrinsic to multiple sclerosis (MS) and is the most commonly reported symptom of the disease". Mult. Scler. 12 (4): 367–8. doi:10.1191/135248506ms1373ed. PMID 16900749.
  19. Sadovnick AD, Eisen K, Ebers GC, Paty DW (August 1991). "Cause of death in patients attending multiple sclerosis clinics". Neurology. 41 (8): 1193–6. PMID 1866003.
  20. Stenager EN, Stenager E (December 1992). "Suicide and patients with neurologic diseases. Methodologic problems". Arch. Neurol. 49 (12): 1296–303. PMID 1449409.
  21. Wintner A, Kim MM, Bechis SK, Kreydin EI (April 2016). "Voiding Dysfunction in Multiple Sclerosis". Semin Neurol. 36 (2): 219–20. doi:10.1055/s-0036-1582255. PMID 27116728.
  22. Hennessey A, Robertson NP, Swingler R, Compston DA (November 1999). "Urinary, faecal and sexual dysfunction in patients with multiple sclerosis". J. Neurol. 246 (11): 1027–32. PMID 10631634.
  23. Deloire MS, Salort E, Bonnet M, Arimone Y, Boudineau M, Amieva H, Barroso B, Ouallet JC, Pachai C, Galliaud E, Petry KG, Dousset V, Fabrigoule C, Brochet B (April 2005). "Cognitive impairment as marker of diffuse brain abnormalities in early relapsing remitting multiple sclerosis". J. Neurol. Neurosurg. Psychiatry. 76 (4): 519–26. doi:10.1136/jnnp.2004.045872. PMC 1739602. PMID 15774439.
  24. Rao SM, Leo GJ, Bernardin L, Unverzagt F (May 1991). "Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction". Neurology. 41 (5): 685–91. PMID 2027484.
  25. Huijbregts SC, Kalkers NF, de Sonneville LM, de Groot V, Reuling IE, Polman CH (July 2004). "Differences in cognitive impairment of relapsing remitting, secondary, and primary progressive MS". Neurology. 63 (2): 335–9. PMID 15277630.
  26. Foley PL, Vesterinen HM, Laird BJ, Sena ES, Colvin LA, Chandran S, MacLeod MR, Fallon MT (May 2013). "Prevalence and natural history of pain in adults with multiple sclerosis: systematic review and meta-analysis". Pain. 154 (5): 632–42. doi:10.1016/j.pain.2012.12.002. PMID 23318126.
  27. Zivadinov R, Zorzon M, Bosco A, Bragadin LM, Moretti R, Bonfigli L, Iona LG, Cazzato G (December 1999). "Sexual dysfunction in multiple sclerosis: II. Correlation analysis". Mult. Scler. 5 (6): 428–31. doi:10.1177/135245859900500i610. PMID 10618700.
  28. Amarenco G, Kerdraon J, Denys P (December 1995). "[Bladder and sphincter disorders in multiple sclerosis. Clinical, urodynamic and neurophysiological study of 225 cases]". Rev. Neurol. (Paris) (in French). 151 (12): 722–30. PMID 8787103.
  29. Schürks M, Bussfeld P (April 2013). "Multiple sclerosis and restless legs syndrome: a systematic review and meta-analysis". Eur. J. Neurol. 20 (4): 605–15. doi:10.1111/j.1468-1331.2012.03873.x. PMID 23078359.
  30. Swanton J, Fernando K, Miller D (2014). "Early prognosis of multiple sclerosis". Handb Clin Neurol. 122: 371–91. doi:10.1016/B978-0-444-52001-2.00015-7. PMID 24507526.
  31. 31.0 31.1 Weinshenker BG (1994). "Natural history of multiple sclerosis". Ann. Neurol. 36 Suppl: S6–11. PMID 8017890.
  32. Confavreux C, Vukusic S, Moreau T, Adeleine P (November 2000). "Relapses and progression of disability in multiple sclerosis". N. Engl. J. Med. 343 (20): 1430–8. doi:10.1056/NEJM200011163432001. PMID 11078767.
  33. Tremlett H, Paty D, Devonshire V (January 2006). "Disability progression in multiple sclerosis is slower than previously reported". Neurology. 66 (2): 172–7. doi:10.1212/01.wnl.0000194259.90286.fe. PMID 16434648.
  34. Confavreux C, Vukusic S (March 2006). "Age at disability milestones in multiple sclerosis". Brain. 129 (Pt 3): 595–605. doi:10.1093/brain/awh714. PMID 16415309.
  35. Confavreux C, Vukusic S (March 2006). "Natural history of multiple sclerosis: a unifying concept". Brain. 129 (Pt 3): 606–16. doi:10.1093/brain/awl007. PMID 16415308.
  36. Langer-Gould A, Popat RA, Huang SM, Cobb K, Fontoura P, Gould MK, Nelson LM (December 2006). "Clinical and demographic predictors of long-term disability in patients with relapsing-remitting multiple sclerosis: a systematic review". Arch. Neurol. 63 (12): 1686–91. doi:10.1001/archneur.63.12.1686. PMID 17172607.
  37. Kremenchutzky M, Rice GP, Baskerville J, Wingerchuk DM, Ebers GC (March 2006). "The natural history of multiple sclerosis: a geographically based study 9: observations on the progressive phase of the disease". Brain. 129 (Pt 3): 584–94. doi:10.1093/brain/awh721. PMID 16401620.
  38. Cree BA, Khan O, Bourdette D, Goodin DS, Cohen JA, Marrie RA, Glidden D, Weinstock-Guttman B, Reich D, Patterson N, Haines JL, Pericak-Vance M, DeLoa C, Oksenberg JR, Hauser SL (December 2004). "Clinical characteristics of African Americans vs Caucasian Americans with multiple sclerosis". Neurology. 63 (11): 2039–45. PMID 15596747.
  39. Roudbari SA, Ansar MM, Yousefzad A (July 2013). "Smoking as a risk factor for development of Secondary Progressive Multiple Sclerosis: A study in IRAN, Guilan". J. Neurol. Sci. 330 (1–2): 52–5. doi:10.1016/j.jns.2013.04.003. PMID 23628463.
  40. Thangarajh M, Gomez-Rial J, Hedström AK, Hillert J, Alvarez-Cermeño JC, Masterman T, Villar LM (November 2008). "Lipid-specific immunoglobulin M in CSF predicts adverse long-term outcome in multiple sclerosis". Mult. Scler. 14 (9): 1208–13. doi:10.1177/1352458508095729. PMID 18755821.

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