A recent study set out to determine the long-term clinical outcomes in MS, and to identify early prognostic features of these outcomes. The findings suggest infratentorial lesions and deep white matter lesions at year one were the strongest early predictors of secondary progressive MS at 30 years.

132 people presenting with a clinically isolated syndrome were recruited by researchers in the UK, Netherlands, and Spain between 1984 and 1987, and followed up clinically and radiologically one, five, 10, 14, 20 and 30 years later. All available notes and MRI scans were reviewed. MS was defined according to the 2010 McDonald criteria.

Clinical outcome data was obtained in 120 participants at 30 years old. Eighty were known to have developed MS the age of 30. Expanded disability status scale scores were available in 107 participants, of whom 77 had MS: 42 percent remained fully ambulatory, all of whom had relapsing-remitting MS; 4 percent had relapsing MS with an EDSS score of greater than 3.5; 34 percent had secondary progressive MS, all of whom had EDSS score of greater than 3.5; and MS contributed to death in 20 percent. Of those with MS, 11 have been treated with a DMT. 

The researchers found the strongest early predictors (within five years of presentation) of secondary progressive MS at 30 years were presence of baseline infratentorial (the region of the brain that contains the cerebellum) lesions and deep white matter lesions at one year.

Thirty years after onset, in a largely untreated cohort, there was a divergence of MS outcomes; some people accrued substantial disability early on, while others ran a more favorable long-term course. These outcomes could, in part, be predicted by radiological findings from within a year of first presentation.

The findings were published in the Annals of Neurology.