Multiple Sclerosis (MS)


Multiple sclerosis (MS) is a disabling disease that affects many organs and systems in the body. Although the disease itself is rarely fatal, it can cause many complications that reduce patients’ life expectancy. 

The life expectancy of patients with MS is 7 to 14 years shorter than that of the general population, but this gap is diminishing as available treatments improve. The average life expectancy of a patient with MS is, on average, 35 years from disease onset.1 The chance that they will still be able to walk unaided 15 years after disease onset is 50%.2

Multiple Sclerosis Complications

MS can cause many complications, some of which are a direct result of the disease and others that are a consequence of MS treatments.3

The main complication that occurs as MS progresses is vision problems such as blurry vision, diplopia, nystagmus, and in more severe cases, vision loss. Other common complications include bladder and bowel problems, such as constipation, diarrhea, and urinary and fecal incontinence. 

MS can also cause cognitive impairment and mental health complications. Cognitive issues may include memory loss, slower intellectual processing, reduced ability to problem-solve, and impairment of verbal and visual-spatial abilities. 

Anxiety, depression, and bipolar disorder are also more common in patients with MS than in the general population.4 These complications could be the result of neuronal damage caused by the disease, the burden of having to live with a chronic condition, or a side effect of certain medications, such as corticosteroids used to treat MS relapses.

Other complications related to the use of corticosteroids include weight gain, mood disorders,  infections, hypertension, ocular hypertension, hyperglycemia, thrombocytopenia, fractures, cataracts, bruises, adrenal insufficiency, and venous thromboembolism.5

Venous thromboembolism can also be the result of MS complications such as disability, spasticity, and reduced mobility, although the risk is low.6

Common Causes of Death

The most common causes of death in patients with MS are the result of secondary complications caused by the disease.1 Complications that contribute to death in patients with MS include respiratory infections, urinary tract infections, sepsis, and skin disease. Other attributed causes are associated with advanced disability and immobility and include aspiration pneumonia and chronic respiratory disease.7

Research has shown that death by suicide is higher among patients with MS than the rest of the population. However, the rate of suicide does not correlate with the severity of the disability.8

Factors Affecting MS Prognosis

Many factors affect prognosis in MS. These include sex, with male sex being an unfavorable factor; a patient’s yearly relapse rate; whether recovery from the first attack is complete; the time interval between the first and second attack; the age of disease onset; the level of disability 2 to 5 years after disease onset; the time of cerebellar involvement; and the number of central nervous system involvements at the time of disease onset. The predominance of motor symptoms (or symptoms from efferent systems) also seems to be an unfavorable factor affecting prognosis compared to sensory symptoms (from afferent systems).2

Lifestyle factors such as smoking status, alcohol consumption, and diet can also have a considerable effect on the prognosis of MS.9

Treatments That Can Prolong Life Expectancy

Disease-modifying treatments, such as interferon beta medications, can have a positive impact on MS prognosis. Research has shown that patients who took interferon beta medications for 3 years or more had a lower risk of death than patients who had not taken them.10 This benefit in life expectancy was maintained even for patients who started treatment more than 5 years after disease onset or after they were age 40.

The potential beneficial effects of other, newer disease-modifying treatments on prognosis remain to be investigated as they become more widely used by the MS patient community. 

Carefully monitoring other health conditions not related to MS, such as hyperlipidemia, hypercholesterolemia, hypertension, and hyperglycemia, as well as the mental health of patients, is also important in prolonging life expectancy.

Finally, physical activity plays an important role in supporting the health of patients with MS and may prolong life expectancy. The National Multiple Sclerosis Society published exercise and physical activity recommendations for all people with MS regardless of the level of disability.11 According to the guidelines, patients with MS should engage in at least 150 minutes of aerobic and breathing exercise and/or lifestyle physical activity per week. Depending on the patient’s abilities, lifestyle physical activities may include active gaming, active weight shifting, seated dancing, yoga, and boxing.

References

  1. Scalfari A, Knappertz V, Cutter G, Goodin DS, Ashton R, Ebers GC. Mortality in patients with multiple sclerosis. Neurology. 2013;81(2):184-192. doi:10.1212/WNL.0b013e31829a3388 
  2. Lectures: prognosis. Health Sciences Library, University of Utah. Accessed June 11, 2021.
  3. Multiple sclerosis (MS). University of Rochester Medical Center. Accessed June 11, 2021.
  4. Chwastiak LA, Ehde DM. Psychiatric issues in multiple sclerosis. Psychiatr Clin North Am. 2007;30(4):803-817. doi:10.1016/j.psc.2007.07.003
  5. Yasir M, Goyal A, Bansal P, Sonthalia S. Corticosteroid adverse effects. StatPearls. Updated March 3, 2021. Accessed June 11, 2021.
  6. Christensen S, Farkas DK, Pedersen L, Miret M, Christiansen CF, Sørensen HT. Multiple sclerosis and risk of venous thromboembolism: a population-based cohort study. Neuroepidemiology. 2012;38(2):76-83. doi:10.1159/000335496
  7. Harding K, Zhu F, Alotaibi M, Duggan T, Tremlett H, Kingwell E. Multiple cause of death analysis in multiple sclerosis: a population-based study. Neurology. 2020;94(8):e820-e829. doi:10.1212/WNL.0000000000008907
  8. Feinstein A, Pavisian B. Multiple sclerosis and suicide. Mult Scler. 2017;23(7):923-927. doi:10.1177/1352458517702553
  9. Jakimovski D, Guan Y, Ramanathan M, Weinstock-Guttman B, Zivadinov R. Lifestyle-based modifiable risk factors in multiple sclerosis: review of experimental and clinical findings. Neurodegener Dis Manag. 2019;9(3):149-172. doi:10.2217/nmt-2018-0046
  10. Kingwell E, Leray E, Zhu F, et al. Multiple sclerosis: effect of beta interferon treatment on survival. Brain. 2019;142(5):1324-1333. doi:10.1093/brain/awz055
  11. Exercise and physical activity recommendations for all people with MS: guidelines and videos available. National Multiple Sclerosis Society. May 14, 2020. Accessed June 11, 2021.

Reviewed by Kyle Habet, MD, on 7/1/2021.

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