Developing an accurate prognosis for an individual MS patient is notoriously difficult owing to the multitude of variables involved. Many studies suggest that the rate of progression to disability may vary due to a number of factors, including: age of onset, clinical type of disease, nervous system pathways involved, attack frequency, patient ability to compensate and patient comorbidities. The majority of patients experience MS as an incrementally disabling disease that evolves over decades. Most can expect a nearly normal lifespan with a cause of death similar to the general population.

• McLeod, J; Barnett; et al. (2007)
  • Median survival time was 42 years from onset
  • There was no difference in the survival time of males vs. females
  • Time to reach DSS3 is about 7 years following onset
  • Time to reach DSS6 is about 27 years following onset
• Hirst, C; Swingler,R; et al have published a study detailing the mortality statistic associated with MS.
  • Median survival time was 38 years from onset
  • Mean age at death from MS related causes: female 65.3 years and male 65.2 years
  • MS related deaths were associated with a younger age of disease onset.
  • Most common cause of MS related death was due to respiratory disease
• Langer-Gould A; Popat RA; found the following factors to be associated with long-term disability in patients with relapsing-remitting multiple sclerosis:
• Sphincter symptoms at onset was strongly and consistently associated with poor prognosis
• Patients with high rates of motor and sphincter relapses are at high risk of developing SPMS
• Incomplete recovery from the first attack was strongly and consistently associated with poor prognosis
• A longer time to a second attack decreased the risk of developing long-term disability.
• Gender and age at onset demonstrated inconsistent or weak effects on prognosis.
• Clinical symptoms consistent with the involvement of multiple neuroanatomical regions at onset were associated with a slightly worse prognosis
• Kremenchutzky, M; Rice, G. P. A.; et al. found that 80% of patients advance from the onset of remitting-relapsing phase to a progressively disabling phase within 2 decades.
• Progression to Disability Status Scale (DSS) 6, 8 and 10 occurred in 12.7, 20.6 and 43.9 years, respectively.
• Age at disease onset of progressive phase was different between groups (38.6, 33.3 and 29.8 years in Primary Progressive -MS, Single Attack Progressive-MS and Secondary Progressive-MS respectively)
• The systems most commonly involved at onset of disease were sensory (36.6%) and pyramidal (33.8%).
• Bergamaschi R; Quaglini, S; et al. developed a tool identifying early clinical predictors of advancement to Secondary Progressive-MS including:
  • Late age onset
  • Polysymptomatic onset
  • Sphincter or motor relapse
  • Early increase in disability

While some patients will maintain independance, those whose disability cannot be managed at home may need placement in an assisted living center or skilled nursing facility. The National Multiple Sclerosis Society states that "only about 5–10% of the MS population requires chronic nursing home care"*. In general, MS nursing home residents are younger, well educated and their intellect is largely intact. MS patients that require nursing home placement often have some form of cognitive impairment. The National Multiple Sclerosis Society suggests that "A neuropsychology consult can be invaluable in defining the cognitive issue(s) and working with staff and the resident to compensate for it. Impairment of judgment, planning and organizational function may have an impact on the safety of operating wheelchairs, especially power-operated wheelchairs or scooters. An occupational therapist should be consulted to address issues of safe driving for individuals with MS who are experiencing cognitive problems."

As patients with MS age, common age-associated changes may complicate the management of MS patients in facilities primarily designed for aging adults. Other chronic illnesses such as osteoporosis, stroke, and diabetes may compound the management of these patients. Shared apartments with attendant care, group residences, and adult day treatment centers are potential settings where independent living can be promoted and nursing home placement for persons with severe MS can be delayed.

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