The prognostic value of age, gender, pregnancy and endocrine factors in multiple sclerosis

The evolution of multiple sclerosis at the time of diagnosis remains unpredictable since a reliable prognostic marker is not yet available. Nevertheless, a series of useful prognostic indicators have been singled out from epidemiological studies. Young age at onset, female gender, relapsing/remitting course, and sensitive or visual disturbances as initial symptoms are considered favourable prognostic factors. Conversely, late age at onset, male gender, progressive course, and pyramidal or cerebellar symptoms at the first episode predict an unfavourable evolution. Another prognostic indicator has been recognized in pregnancy: although the overall effect of pregnancy on short-term MS course is neutral, in the long-term it seems to protect from disease progression. Most prognostic indicators seem to act through the neuro-endocrine-immune network, modulating the immune response in the context of the Th1/Th2 paradigm.