Table 3.

Summary of the main negative prognostic factors predicting disability progression in MS patients

Predictors

Patient’s demographics and environmental factors

Non-Caucasian

Older age

Male sex

Obesity (particularly in childhood and adolescence)

Smoking

Clinical factors

Onset with motor, cerebellar, or bladder/bowel symptoms

Multifocal onset (≥ 2 functional systems involved simultaneously)

Higher relapse rate in the first 2–5 years from disease onset

Short inter-attack latency

Incomplete recovery after a relapse

Severe clinical relapses

Higher disability accumulation in the first 2–5 years from disease onset

Continued disease activity despite DMT

Shorter time to conversion to SPMS

Cognitive impairment

Biochemical factors

Presence of cerebrospinal OCBs

High NfL level

Neuroradiological factors

Higher number and volume of T2-hyperintense lesions

Brainstem and cerebellar lesions

Spinal cord lesions (especially affecting the central GM)

T1-hypointense lesions (“black-holes”)

Cortical lesions

Presence of gadolinium-enhancing lesions

New T2 lesions formation in the first 5 years

Chronic active lesions (paramagnetic iron rim or slowly expanding)

Brain atrophy (especially GM)

Spinal cord atrophy (especially GM)

GM gray matter; NfL neurofilament light chain, OCB oligoclonal bands, SPMS secondary progressive multiple sclerosis