Question 23

What are positive and negative factors in Joe's history or examination (or in a general patient with MS's history or examination) that would possibly affect his prognosis? (What factors indicate a severe or rapid progression of the disease? What factors indicate a less severe form of the disease or slower progression?)

For example: The presence of significant pyramidal or cerebellar signs at 5 years with involvement at multiple sites is a negative sign, associated with a poorer prognosis and more severe disability.

1.) Risk for rapid development of moderate disability may be greater in persons in whom the frequency of attacks is higher than average. Numerous relapses withint he first year negatively influence the course of progression. (Ben) pg. 1435

What is the average frequency of attacks?

2.) A patient with MS that is mildly disabled the death rate increases 1.5 times compared to a person of the same age without MS. A patient with MS that can not stand or walk has a death rate 4 times that of the same person without the disease. This is could be a negative factor in Joe's history if he can not stay ambulatory or becomes disabled. (Marleigh K.) Pathophysiology book pg 1436

3.) A patient with primary progressive disease has decreased life expectancy. Suicide is more than seven times more common than in age-matched controls. (Liz) Pathophysiology book pg. 1436.

4.) A patient with primary-progressive type of MS has a decreased life expectancy compared to the other types of MS. (Britt) Pathophysiology book pg. 1436

5.) Joe's history of smoking may also affect the progression of his MS s/s. Smoking increase the risk of developing MS as well as increasing the severity and speed of progression. http://www.nationalmssociety.org/about-multiple-sclerosis/what-we-know-about-ms/treatments/exacerbations/smoking-and-alcohol/index.aspx
(Megan)

Looking on the optimistic side, a positive factor in Joe's situation could just be the fact that he is in seeing a physical therapist. Physical therapy can help Joe recover function faster! (Denise)

Expanding on what Denise said. Not only can treatment help Joe recover faster, it can make his prognosis better. Receiving earlier treatment can greatly reduce Joe’s chances of requiring assistive devices to walk or be bound to a wheelchair. (Steve) Pathology book pg. 1435

Also the fact that Joe is under 30 years old gives him a better prognosis. (Brittany)

The average frequency of attacks is 1 per year. (Drew) pg. 1435 Patho book

The attacks very in severity, and tend to be most common in the early years and less frequent in later years. (John) p. 1435


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