A 42-year-old woman presents with ataxia. Gadolinium-enhanced MRI reveals multiple subcortical white matter lesions as well as enhancing lesions in the cerrebellum and spinal cord. She is diagnosed with MS. Two months later she develops optic neuritis. What feature is associated with a milder disease course?
A. Her age of 42
B. Her initial presentation of ataxia
C. Her female gender
D. The interval between the two episodes of two months
E. Her MRI scan appearance
Ans: Multiple sclerosis prognosis
(C) In this woman’s case, all of the features except her gender (C) point to a more aggressive disease course. Although it is close to impossible to predict an individual patient’s outcome, features of a better prognosis include onset under 25 years (A), optic neuritis or sensory, rather than cerebellar symptoms on initial presentation (B), a long interval (>1 year) between relapses (D) and few lesions on MRI (E). Full recovery from relapses is also a positive feature. Progressive MS carries a poorer prognosis compared to relapsing–remitting MS.