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Multiple sclerosis is a chronic autoimmune disease of the central nervous system (CNS) that affects the brain, spinal cord, and optic nerves. It is an inflammatory demyelinating disorder and a leading cause of neurological disability in young adults.EpidemiologyMS commonly begins between 20 and 40 years of age and is twice as common in women. Its exact cause remains unclear, but genetic susceptibility contributes, with higher risk in first-degree relatives and identical twins. A greater...

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  1. Home
  3. Rethinking Prognosis In Multiple Sclerosis: A Multiaxial Perspective.
  1. Home
  3. Rethinking Prognosis In Multiple Sclerosis: A Multiaxial Perspective.

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Rethinking prognosis in multiple sclerosis: a multiaxial perspective.

Luca Prosperini1, Carla Tortorella1, Frederik Barkhof2,3

  • 1MS Centre, Department of Neurosciences, San Camillo-Forlanini Hospital, Rome, Italy.

Nature Reviews. Neurology
|May 19, 2026

View abstract on PubMed

Summary
This summary is machine-generated.

This study proposes a new multiaxial model for multiple sclerosis (MS) prognosis, integrating damage, injury location, and compensation capacity. This framework aims to improve individualized risk prediction beyond current disease burden assessments.

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Area of Science:

  • Neurology
  • Biomarker Research
  • Medical Imaging

Background:

  • Multiple sclerosis (MS) prognosis remains uncertain despite therapeutic advances.
  • Current prognostic approaches primarily focus on disease burden, neglecting compensatory mechanisms.
  • A unified framework for integrating diverse prognostic factors in MS is lacking.

Purpose of the Study:

  • To propose a multiaxial conceptual model for multiple sclerosis prognosis.
  • To integrate diverse prognostic factors including damage, injury topography, and compensation.
  • To provide a roadmap for future research in MS prognostic modeling.

Main Methods:

  • Review of current research on MS prognosis by the MAGNIMS consortium.
  • Development of a three-axis conceptual model: damage burden, injury topography, and compensation capacity.
  • Evaluation of existing tools (MRI, biofluid markers, evoked potentials, OCT, passive monitoring) for assessing prognostic axes.

    • Main Results:

    • A novel multiaxial conceptual model for MS prognosis is proposed.
    • The model integrates overall damage, lesion location, and compensatory mechanisms.
    • Existing tools and future directions for each axis were assessed.

    Conclusions:

    • The proposed framework offers an integrated approach to individualized risk prediction in MS.
    • This conceptual roadmap aims to guide future research and refine prognostic models.
    • The model is intended as a guide for research, not a prescriptive clinical guideline.