Table 1.

Practical checklist for using personalized prognosis in MS.

(A) Demographic factors impacting on prognosis	Item	Better prognosis		Poorer prognosis
	Age (years)	<30	<40	≥40	≥50
	Older age has been associated with poorer prognosis in MS
	Sex	Female		Male
	Studies show that disability worsening milestones are met earlier in males
	Serum Vitamin D Levels	25(OH)D level		25(OH)D level	25(OH)D level
		>75 nmol/L		50-75 nmol/L	<50 nmol/L
	Vitamin D is a steroid hormone that is involved in many important physiological functions in humans and has been strongly implicated in MS disease activity and disability progression. A negative correlation exists between 25(OH)D levels and disability across all forms of MS (RRMS, SPMS, PPMS)
	Smoking	Non-smoker		Smoker
	Smoking of tobacco products has long been associated with risk of MS and of disease progression
	Comorbidities	No Comorbidities		Comorbidities
				1	2	≥3
	Conditions such as cardiovascular diseases, obesity and psychiatric disorders (depression, anxiety) have been associated with disability progression and reaching disability milestones earlier
(B) Clinical manifestations impacting on prognosis
	Disease subtype	Relapsing forms of MS		Progressive forms of MS
	Disability progression is indicative of a poorer prognosis given the paucity of effective treatment options for progressive versus relapsing forms of MS
	Relapse rate	≤1 in 2 years since diagnosis	<1 per year	1 in previous year	≥2 per year
	The relapse frequency in the first two years since diagnosis is associated with more rapid progress to disability milestones
	Interval between relapses	≥2 years	>1 year	<1 year	<6 months
	The time between first and second relapses is associated with more rapid progress to disability milestones
	Recovery from relapse	Full recovery		Partial recovery
	Complete recovery is a positive prognostic indicator that predicts a slower progression to irreversible disability landmarks
	EDSS at diagnosis	EDSS score ≤2		EDSS score >2
	Higher EDSS values at diagnosis are associated with a poorer prognosis
	Brainstem, cerebellar or spinal cord onset	Absent		Present
	Symptomatic involvement of the pyramidal, cerebellar, sphincteric or visual systems at MS disease onset is unfavourable
	Form of symptomatic onset	Monosymptomatic		Polysymptomatic
	A polysymptomatic onset of MS activity has been associated with poorer recovery and greater disability progression with time
	Cognitive deficits Cognitive impairment at baseline (deficits in information processing speed and verbal memory) are correlated with higher EDSS scores 5 to 7 years later	No cognitive decline		Mild cognitive decline	Moderate / Severe cognitive decline
(C) MRI observations impacting on prognosis
	Number of T2 lesions	Low number of T2 lesions		High number of T2 lesions
		1-4		5-9 ≥10
	Numerous studies point to the fact that the number and volume of brain T2 lesions on MRI scan at diagnosis is correlated to long-term disability outcomes
	Gadolinium(Gd)-enhancing, infratentorial, and spinal cord lesions
		No Gd-enhancing lesions		Presence of Gd-enhancing lesions
	The presence of these lesions in relapsing MS patients at diagnosis or early disease (1-3 years) is correlated with poor long-term outcomes such as conversion to SPMS or increased disability as measured by EDSS	No infratentorial lesions		Presence of infratentorial lesions
		No spinal cord lesions		Presence of spinal cord lesions
	T1 Black holes	No T1 black holes		Presence of T1 black holes
	T1 hypointense (black holes) lesions have been associated with demyelination, axonal loss, and neurodegeneration
(D) Biomarkers
	Oligoclonal bands (OCBs)	No OCBs	Presence of OCBs		Presence of IgM OCBs
	The presence of OCBs is associated with poorer prognosis, whereas the absence of OCBs is associated with to a more benign disease course
	Neurofilament Light (NfL) chain levels in serum	NfL levels <80th percentile for healthy controls	NfL levels ≥80th percentile for healthy controls
	Evidence from numerous studies involving MS patients points to a correlation of high NfL levels with disability progression.
(E) Optical Coherence Tomography (OCT) and Evoked Potentials (EPs)
	Retinal nerve fibre layer (RNFL) properties	RNFL thickness >88 μm at baseline	RNFL thickness ≤88 μm at baseline
	Baseline RNFL thinning is indicative of subclinical axonal damage and early neurodegeneration that can be measured by OCT
	Evoked potential characteristics	0 or 1 abnormal EP	2 abnormal EPs		3 or more abnormal EPs
	Abnormal somatosensory, motor, or global EP scores at baseline are correlated with later disability progression