Rethinking prognosis in multiple sclerosis: a multiaxial perspective

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.