Multiple sclerosis (MS) is a progressive disease, which means it gradually becomes worse. However, depending on the type, it can also involve remissions and flares, so that people often feel better for a while before symptoms appear again.
The first symptoms of MS typically emerge between the ages of 20 and 40 years, and progression varies widely.
The symptoms of MS can affect daily activities and reduce a person's quality of life. However, medical advances in recent years mean that the outlook for MS is improving rapidly.
Find out more here about the stages of MS and how it progresses.
Factors affecting life expectancy
Progress in medical treatment has improved quality of life and life expectancy for people with MS.
Estimates of life expectancy vary because MS affects people in different ways and because the outlook is improving rapidly for people with the condition.
According to the National Institute for Neurological Diseases and Stroke (NINDS), a person with MS can now expect to live as long as a person without the condition.
The National MS Society note that, in rare cases, when the condition progresses rapidly, it can be fatal. They estimate that MS can shorten a person's life by 7 years.
In 2013, scientists reported in the journal Neurology that the life expectancy of people with MS was around 7 to 14 years lower than for people without the condition.
In the past, doctors considered MS to be untreatable. In the last 2 to 3 decades, however, new therapies have emerged that can slow the progress of MS and manage symptoms more effectively in some people.
With new "disease-modifying" therapies (DMTs) and rehabilitation strategies, many people with MS can expect to live more active lives than was possible in the past.
Researchers suggest that it is not usually the direct impact of MS that shortens a person's life, but to the complications that can arise or other conditions that do not relate to MS.
Various factors can affect a person's life expectancy when they have MS. These include:
- the type of MS they have
- their age when symptoms begin
- the severity of their symptoms
- how quickly the symptoms progress
- the length of time between flares
- what treatment they receive
- complications that develop
- the person's quality of life
Most people with MS have relapsing-remitting MS (RRMS). After symptoms first appear, they will experience a relapse once every 2 years, on average. Between relapses, their condition remains stable.
Secondary progressive MS (SPMS) is a progressive type of MS. At first, a person will experience alternating flares and periods of recovery. In time, however, they will start to have fewer sudden relapses but a steady worsening of symptoms.
Primary progressive MS (PPMS) features only a progression of symptoms and no remission. Progressive forms of MS can be more severe and harder to treat.
Most people with MS will see some loss of physical and other ability, but around two-thirds of people with the condition continue to be able to walk, according to the National MS Society.
In time, some who experience MS may need an aid, such as a stick or a walker, to prevent falls and help them conserve energy.
Recent and ongoing medical advances, however, mean that the outlook for a person with MS is improving rapidly, and also the chances of living as long as someone without the condition.
Research over the last 20 to 30 years has produced treatments that target the specific changes that occur in relapsing MS. Specialists call these treatments disease-modifying therapies (DMTs).
There is strong evidence that if a person uses a DMT from the early stages of MS, it can help to prevent relapses and slow the progression of the disease.
The United States Food and Drug Administration (FDA) have approved more than a dozen DMTs for use with MS. In 2018, the American Academy of Neurology (AAN) issued new guidelines for using DMTs to treat MS.
The guidelines suggest using a DMT as a first-line treatment, and as an ongoing therapy, possibly in combination with corticosteroids.
The DMTs include:
- glatiramer acetate (Glatopa)
- interferon b-1a (Avonex, Rebif)
- interferon b-b (Betaseron, Extavia)
- dimethyl fumarate (Tecfidera)
- fingolimod (Gilenya)
- alemtuzumab (Lemtrada)
- ocrelizumab (Ocrevus)
- siponimod (Mayvent)
- mitoxantrone (Novantrone)
- natalizumab (Tysabri)
People can take some of these by mouth, some are injectable, and others a doctor would give as an intravenous infusion.
Mitoxantrone, previously under the brand name Novantrone, is an older DMT that may have serious adverse effects, including cardiomyopathy and fertility problems.
The AAN guidelines suggest that doctors avoid prescribing mitoxantrone if the risk to a person could be greater than the benefit the drug may offer.
People who are using this drug may wish to speak to their doctor about changing to another option. However, there can be adverse effects from changing medication as well.
Doctors may ask a person about their needs and preferences. They may make clear the need to monitor for side effects, and to attend regular checkups to evaluate the individual's progress.
A doctor will discuss the best treatment option with the individual.
As people vary in their response to MS and treatments, doctors and researchers are now focusing on ways to target medication to suit individuals. This involves identifying variations in genes that may play a role in MS.
If damage to a specific gene results in symptoms for one person, for example, targeting that gene may provide effective treatment but with less unnecessary damage to other genes.
If a person finds that their treatment option is not helping, they may wish to speak to their doctor about trying another type.
Recognizing MS relapses
MS involves periods of remission and relapse. A relapse, or flare, is when symptoms suddenly return after a period of improvement. During a time of remission, symptoms may lessen or disappear.
While DMTs can reduce the frequency and severity of relapses, they can still occur.
It is not always easy to spot a relapse before symptoms become severe. Symptoms can occur without warning.
Possible triggers for a relapse include stress and infection. If a person knows one of these conditions has occurred, they can be ready to ask for treatment as soon as their MS symptoms arise.
The person may notice changes in:
- vision, such as blurring or dimming
- feelings, such as prickling or numbness
- thinking, such as difficulty paying attention or focusing on tasks
- bladder control, leading to an increased urgency to urinate
A doctor will need to decide whether or not the symptoms represent a relapse before recommending treatment.
The doctor will consider:
- whether the symptoms remain for at least 24 hours without any fever or infection
- if there could be any other possible reason for the symptoms
If the symptoms appear to be due to an MS relapse, the doctor may suggest a corticosteroid injection to reduce the inflammation.
In the past, corticosteroids played a key role in the treatment of MS. However, they can have adverse effects if people use them long-term, and they may be less effective than some of the newer drugs.
Managing other conditions with MS
Other health conditions can occur alongside MS. Preventing or managing these complications can help to improve a person's quality of life and life expectancy.
A systematic review appearing in 2015 found that the following conditions are "reasonably common" in people with MS when doctors compare them with those who do not have MS and that the risks appear to increase with age.
- ischemic heart disease
- congestive heart failure
- high blood pressure
- high cholesterol
The researchers called for more evidence to confirm how significant the link might be, as it could impact treatment strategies.
The higher incidence of these complications may not be due to MS itself, but to risk factors that are more common in people with MS.
Reduced mobility, for example, can lead to excess weight, and this can impact the risk of cardiovascular disease and diabetes. Balance problems can also increase the risk of falling. This, too might affect a person's life expectancy.
Strategies to address these issues can help to improve a person's quality of life and risk of complications.
- appropriate physical therapy
- a healthful diet
- adaptations and aids at home, such as grab bars, to prevent falls
Click here for more information about a healthful diet for MS.
As with many long-term diseases, a person with MS may have a higher chance of developing depression. Keeping as active as possible, spending time with family and friends, and joining a support group may all help to prevent this.
Improving daily activities and quality of life
MS affects a person's mobility, and it increases the risk of falls.
A study published in the BMJ notes that 52 to 63 percent of people with MS fall at least once over periods of 3 to 6 months, resulting in pain, discomfort, and fear of falling again.
Rehabilitation can help to change behaviors, boost physical confidence and activity levels, and improve a person's quality of life.
In 2012, researchers from a rehabilitation center in Switzerland recommended developing "comprehensive rehabilitation interventions" to reduce the negative impact on a person's daily activity, independence, and quality of life.
They suggested programs that:
- suit the individual's needs
- start at a low to moderate intensity
- involve regular rest periods to cut the risk of further harm
Individual needs will depend on:
- the severity of symptoms
- the stage of the MS
- a person's functioning ability
- personal wishes and needs
The research team suggested that rehabilitation can benefit both mental and physical health. It should also involve education and sharing of information about MS with the individual and their caregivers.
Benefiting from exercise
Exercise can boost a person's physical health and mental well-being.
With MS, increasing or maintaining physical activity levels can bring a range of short- and long-term benefits.
The National MS Society note that some types of exercise may help to improve the following:
- cardiovascular health
- physical strength
- bladder and bowel function
- energy levels
- social life
Low activity levels, on the other hand, can contribute to:
- heart disease
- muscle weakness
- low bone density
- inefficient breathing
Reducing these can all contribute to improving a person's life expectancy.
Targeted exercise programs can improve:
- walking, which also makes it easier to do other exercises
- balance, which reduces the risk of harm from falling
Suitable activities might include:
- yoga or tai chi
- water aerobics
- active household chores
Needs and abilities can vary between individuals and during times of remission and flares.
If possible, it is best to find a program that therapists have designed for people with MS, or an instructor who has an awareness of MS and its physical needs and demands.
A person can ask their doctor about suitable programs, exercises, and other types of support and rehabilitation.
MS is a serious, lifelong illness, and it can be challenging to live with. In the past, it has contributed to a lower life expectancy.
However, in the last few decades, new medications and rehabilitation techniques are making it possible to have a better quality of life with MS, and life expectancy for many is the same as for a person without the condition.