Editing Multiple sclerosis (section)

== Prognosis ==
The availability of treatments that modify the course of multiple sclerosis beginning in the 1990s, known as disease-modifying therapies (DMTs), has improved prognosis. These treatments can reduce relapses and slow progression, but there is no cure.<ref name=McGinley2021/><ref name=Cree2022>{{cite journal |vauthors=Cree BA, Hartung HP, Barnett M |title=New drugs for multiple sclerosis: new treatment algorithms |journal=Curr Opin Neurol |volume=35 |issue=3 |pages=262–270 |date=June 2022 |pmid=35674067 |doi=10.1097/WCO.0000000000001063 |s2cid=249438715 |url=|doi-access=free }}</ref>

The prognosis of MS depends on the subtype of the disease, and there is considerable individual variation in the progression of the disease.<ref name=Oh2018/> In relapsing MS, the most common subtype, a 2016 cohort study found that after a median of 16.8 years from onset, one in ten needed a walking aid, and almost two in ten transitioned to secondary progressive MS, a form characterized by more progressive decline.<ref name=McGinley2021/> With treatments available in the 2020s, relapses can be eliminated or substantially reduced. However, "silent progression" of the disease still occurs.<ref name=Cree2022/><ref>{{cite journal |vauthors=Hauser SL, Cree BA |title=Treatment of Multiple Sclerosis: A Review |journal=Am J Med |volume=133 |issue=12 |pages=1380–1390.e2 |date=December 2020 |pmid=32682869 |doi=10.1016/j.amjmed.2020.05.049 |pmc=7704606 |url=}}</ref>

In addition to secondary progressive MS (SPMS), a small proportion of people with MS (10–15%) experience progressive decline from the onset, known as primary progressive MS (PPMS). Most treatments have been approved for use in relapsing MS; there are fewer treatments with lower efficacy for progressive forms of MS.<ref name="Continuum">{{cite journal |vauthors=Ontaneda D |title=Progressive Multiple Sclerosis |journal=Continuum |volume=25 |issue=3 |pages=736–752 |date=June 2019 |pmid=31162314 |doi=10.1212/CON.0000000000000727 |s2cid=174808956 |url=}}</ref><ref name=Cree2022/><ref name="McGinley2021" /> The prognosis for progressive MS is worse, with faster accumulation of disability, though with considerable individual variation.<ref name=Continuum/> In untreated PPMS, the median time from onset to requiring a walking aid is estimated as seven years.<ref name=McGinley2021/> In SPMS, a 2014 cohort study reported that people required a walking aid after an average of five years from the onset of SPMS, and were chair or bed-bound after an average of fifteen years.<ref>{{cite journal |vauthors=Inojosa H, Proschmann U, Akgün K, Ziemssen T |title=A focus on secondary progressive multiple sclerosis (SPMS): challenges in diagnosis and definition |journal=J Neurol |volume=268 |issue=4 |pages=1210–1221 |date=April 2021 |pmid=31363847 |doi=10.1007/s00415-019-09489-5 |s2cid=198999832 |url=}} [[Expanded Disability Status Scale]] (EDSS) 6.0 is equivalent to requiring a walking aid, and EDSS 8.0 equivalent to chair or bedbound</ref>

After diagnosis of MS, characteristics that predict a worse course are male sex, older age, and greater disability at the time of diagnosis; female sex is associated with a higher relapse rate.<ref name=lancet2018>{{cite journal |vauthors=Thompson AJ, Baranzini SE, Geurts J, Hemmer B, Ciccarelli O |title=Multiple sclerosis |journal=Lancet |volume=391 |issue=10130 |pages=1622–1636 |date=April 2018 |pmid=29576504 |doi=10.1016/S0140-6736(18)30481-1 |s2cid=4313310 }}</ref> Currently, no biomarker can accurately predict disease progression in every patient.<ref name=Oh2018/> Spinal cord lesions, abnormalities on MRI, and more [[Cerebral atrophy|brain atrophy]] are predictive of a worse course, though brain atrophy as a predictor of disease course is experimental and not used in clinical practice.<ref name="lancet2018" /> Early treatment leads to a better prognosis, but a higher relapse frequency when treated with DMTs is associated with a poorer prognosis.<ref name=Oh2018/><ref name=lancet2018/> A 60-year longitudinal population study conducted in Norway found that those with MS had a [[life expectancy]] seven years shorter than the general population. Median life expectancy for RRMS patients was 77.8 years and 71.4 years for PPMS, compared to 81.8 years for the general population. Life expectancy for men was five years shorter than for women.<ref>{{cite journal | vauthors = Lunde HM, Assmus J, Myhr KM, Bø L, Grytten N | title = Survival and cause of death in multiple sclerosis: a 60-year longitudinal population study | journal = Journal of Neurology, Neurosurgery, and Psychiatry | volume = 88 | issue = 8 | pages = 621–625 | date = August 2017 | pmid = 28365589 | pmc = 5537547 | doi = 10.1136/jnnp-2016-315238 }}</ref>