Multiple sclerosis (MS) is a condition marked by considerable prognostic uncertainty, despite advances in therapeutic strategies and biomarker development. Current approaches to prognosis are largely focused on disease burden, failing to consider the influence of compensatory mechanisms, which complicate the evaluation of long-term outcomes.
No unified framework currently exists to guide the integration of diverse prognostic factors, ranging from lesion burden and location to neuroaxonal injury, structural and cognitive reserve, lifestyle and digital biomarkers. To address this gap, a consortium from the Magnetic Resonance Imaging in MS (MAGNIMS) network has reviewed the latest research on MS prognosis and, in this Expert Recommendation, proposes a multiaxial conceptual model that incorporates the overall burden of damage, the topography of injury and the capacity for compensation.
These three axes can be explored with different tools, such as clinical history and neurological examination, MRI-based tools, biofluid markers and additional techniques, including multimodal evoked potentials, optical coherence tomography and technology-based passive monitoring systems.
Nature Reviews Neurology published a clinical update in Neurology on 19 May 2026.
The item focuses on Rethinking prognosis in multiple sclerosis: a multiaxial perspective.
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