http://neurology.medscape.com/Medscape/Neurology/AskExperts/MS/2001/07/NEUR-ae87.html

07/24/01

Question

What is the prognosis for a 14-year-old child with clinical and magnetic resonance imaging (MRI)-confirmed multiple sclerosis (MS)? Can plaques disappear? Would clinical symptoms improve in such a case?

Response

from Mark S. Freedman, MD, 07/24/01

It used to be claimed that a younger age of onset of MS was associated with a better prognosis, but long-term studies are now calling that into question. A number of prognostic factors have been suggested, but most of these are considered "soft," because the course of disease can be quite variable. The number of relapses in the first few years, the lack of recovery from relapses with early persistent neurologic changes, and the number and size of lesions seen on the MRI can all have some prognostic significance.

Plaques are always in a dynamic state, meaning they change. Pathologically, it's unlikely that they ever really disappear, but, from an MRI perspective, they can certainly come and go, depending on the type of images one obtains. With regard to clinical symptoms, that is quite variable. Sometimes lesions, although healed, can still produce symptoms owing to the fact that the nervous system is basically a very complicated electrical system, and a healed lesion might lead to electrical "short circuits" in which symptoms can appear, but last only seconds or minutes. Many lesions are clinically "silent" because either they affect areas of the nervous system for which there are many duplicate pathways, or areas that don't deal with the more important and obvious functions such as vision, motor strength, balance, or sensation. Whether certain symptoms will improve is really based on what those symptoms are and what they result from (ie, a new lesion or a healed lesion that is acting up by causing "short circuits").

Suggested Reading

Amato MP, Ponziani G. A prospective study on the prognosis of multiple sclerosis. Neurol Sci. 2000;21(4 suppl 2):S831-S838.

Liguori M, Marrosu MG, Pugliatti M, et al. Age at onset in multiple sclerosis. Neurol Sci. 2000;21(4 suppl 2):S825-S829.

Miller DH, Thompson AJ, Kappos L. MRI and assessment of treatment in multiple sclerosis. Brain. 2001;124(Pt 5):1052-1053.

Myhr KM, Riise T, Vedeler C, et al. Disability and prognosis in multiple sclerosis: demographic and clinical variables important for the ability to walk and awarding of disability pension. Mult Scler. 2001;7:59-65.

Pinhas-Hamiel O, Sarova-Pinhas I, Achiron A. Multiple sclerosis in childhood and adolescence: clinical features and management. Paediatr Drugs. 2001;3:329-336.

Rovaris M, Filippi M. Contrast enhancement and the acute lesion in multiple sclerosis. Neuroimaging Clin N Am. 2000;10:705-716,viii-ix.

Rudick RA, Cutter G, Baier M, et al. Use of the Multiple Sclerosis Functional Composite to predict disability in relapsing MS. Neurology. 2001;56:1324-1330.