Multiple sclerosis prognosis and life expectancy

Last updated July 7, 2025, by Marisa Wexler, MS
Fact-checked by Ines Martins, PhD

Multiple sclerosis (MS) is a chronic, lifelong disease that can cause progressive disability and increase the risk of serious complications. But the condition itself isn’t usually fatal, and life expectancy for people with MS has improved considerably over the past decades.

Advances in care, especially the use of more effective disease-modifying therapies (DMTs), have greatly improved the outcomes for people with MS, allowing many people to lead long, active lives and maintain their independence for longer.

MS prognosis varies a lot from person to person, depending on factors such as overall health, how quickly the disease progresses, and how well the patient responds to treatment. Still, with modern care, the average MS life span is now only a few years shorter than that of the general population.

Is MS fatal?

MS itself is not usually fatal. However, the disorder may increase the risk of life-threatening complications, such as severe infections or swallowing difficulties, that can set the stage for pneumonia.

Complications that may affect MS life expectancy include: 

• urinary or respiratory tract infections
• issues with swallowing, which may lead to aspiration pneumonia (a lung infection that develops when someone aspirates food or fluids into the windpipe)
• cardiovascular issues, which are more common in people with MS.

Currently, the average life expectancy with MS is estimated to be five to 10 years shorter than that of the general population. However, this gap in mortality risk in MS is narrowing due to improvements in diagnosis, more effective treatments, and better care.

How MS progresses over time

MS is a progressive disease, but how it progresses varies widely from person to person.

For most people, MS begins with a relapsing-remitting disease course (RRMS), which is characterized by episodes of new or worsening symptoms (relapses), followed by periods of partial or complete recovery (remission).

Over time, some people with RRMS may transition into another form of the disease, called secondary progressive MS (SPMS), in which symptoms continually worsen over time, even when no relapses occur.

The time someone takes to progress from RRMS to SPMS varies substantially, but evidence suggests that treatment with DMTs can significantly delay this progression. Before the widespread availability of DMTs, about half of RRMS patients would progress to SPMS within 10-20 years of disease onset. But with modern care, this number has dropped substantially, with one large study reporting that about 10% of patients converted to SPMS over a median of 32 years.

In approximately 10%-15% of cases, MS takes on a progressive course from the very beginning. This form is known as primary progressive MS (PPMS), and it’s characterized by a steady accumulation of symptoms and disability from disease onset, typically without clear relapses or remissions.

In general, symptoms tend to worsen more quickly in progressive forms of MS than in relapsing forms. As such, an RRMS prognosis is generally more favorable than a PPMS prognosis, with people with RRMS often experiencing a slower accumulation of disabling symptoms and having a higher MS survival rate.

Although MS is often categorized as either relapsing or progressive, as if these were completely separate categories, they are in fact far from absolute and frequently overlap. People with progressive MS can sometimes experience disease relapses and periods of relative remission, and recent evidence shows that individuals with relapsing disease often experience increases in disability that are not related to any recent relapse activity.

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This form of progression, which is now recognized as one of the main mechanisms of disability accumulation in MS, is called progression independent of relapse activity, or PIRA.

EDSS: Measuring disability progression

Disability progression in people with MS is usually tracked with a standardized measure called the Expanded Disability Status Scale, or EDSS. This scale ranges from 0, indicating no disability, to 10, for death. Scores increase in increments of 0.5 as disability progresses.

EDSS scores from 0 to 4.5 mean that individuals are able to walk without any aid. At these lower scores, disability is measured based on impairments in functional systems, which represent groups of nerves responsible for specific tasks. Each is graded on a scale of 0 (no disability) to 5 or 6 (severe disability).

The EDSS assesses eight functional systems:

• pyramidal, or muscle weakness or trouble moving the limbs
• cerebellar, referring to coordination problems, loss of balance, and tremor
• brainstem, referencing uncontrolled eye movements and difficulty talking or swallowing
• sensory, or numbness or unusual sensations
• bowel and bladder, for changes in gastrointestinal and urinary tract function
• visual, for problems with vision
• cerebral, referencing difficulty with thinking or memory
• other, for any other neurologic finding attributed to MS.

From scores of 5 to 9.5, the EDSS is assessed mainly based on an individual’s ability to walk.

Factors affecting prognosis

No two people with MS experience the disease exactly the same way. Much like there are risk factors for developing MS, there are various factors that can affect the disease’s course, including how frequently relapses occur and how fast symptoms worsen.

Several key factors are known to impact MS prognosis. These include:

• treatment, especially the early and sustained use of DMTs
• lifestyle factors, such as exercise, diet, smoking, and stress management
• biological and disease-specific factors, including age at symptom onset and early disease activity
• demographic characteristics, such as sex, race, and ethnicity.

Treatment

Treatment is perhaps the factor that mostly influences the trajectory of MS in the modern day. Several DMTs, or medications that help reduce disease activity and reduce the risk of long-term disability, are approved for all the main MS types.

These therapies work by targeting the immune system to reduce inflammation in the brain and spinal cord. Clinical trials and real-world studies have shown that DMTs can:

• reduce the frequency of relapses
• lower the number of new or active brain lesions
• delay the accumulation of disability over time.

While DMTs can help prevent future nerve damage and slow MS disease progression, they usually cannot reverse damage and disability that’s already occurred. For this reason, it’s recommended that MS treatment is started as early as possible. The long-term outlook for MS is generally better for patients who receive a DMT early in the course of their disease.

Each MS treatment has its own safety and efficacy profile, and there is no single option that works best for everyone. Patients should talk with their healthcare team to learn which medications might be more appropriate for their individual needs and preferences.

Lifestyle factors

A healthy lifestyle can complement medical treatment and potentially improve long-term MS outcomes. In addition to improving overall health, adopting healthy habits — such as getting frequent exercise or eating a well-balanced diet — can also affect the progression of MS.

• Exercise is key. Regular physical activity has been linked to better physical function and cognitive performance in people with MS. It may also help slow the accumulation of disability, though definitive evidence is lacking.

• Smoking should be stopped. Smoking cigarettes is a well-established risk factor for both developing MS and for faster disease progression. People who smoke are more likely to experience more frequent relapses and rapid disability progression, and they may also experience reduced effectiveness from DMTs.
• Diet is important. While there’s no specific MS diet, people with MS should try to eat nutritious, balanced meals rich in fruits, vegetables, whole grains, and lean proteins. This can help ease certain MS symptoms and may also help lower relapse rates and reduce the risk of disability progression.
• Stress management is needed. Reducing stress through mindfulness or other stress-reducing activities may improve quality of life and potentially slow disability progression, though more evidence is needed.

Biological and disease-related factors

Certain characteristics of the disease itself, or of the patient, can also affect and individual’s MS prognosis.

• Age at onset may play a role. MS that begins at an older age tends to progress more quickly, while younger onset often involves more frequent relapses but slower disability accumulation.
• The early MS course can be a factor. A higher number of relapses or a faster increase in disability early in the disease is linked to a worse prognosis and earlier progression to higher disability scores. Poor recovery after a first relapse, and a shorter interval between the first two relapses, also seem to increase the risk of disability progression.
• MRI findings may be predictive. More extensive lesions, especially in certain brain regions, and evidence of brain shrinkage, or atrophy, on MRI scans are generally associated with a higher risk of disability progression and a less favorable prognosis.
• Obesity may have an effect. Obesity may contribute to faster disease progression, poorer quality of life, and more rapid cognitive decline, likely due to its role in promoting chronic inflammation.

Demographic factors

Demographic characteristics can also play a role in how MS progresses.

• Race and ethnicity may have an effect. Black or Hispanic people tend to experience more severe disease and faster disability progression than white patients. They also tend to die at younger ages compared with their white counterparts. These differing outcomes are thought to arise due to a complex interplay of genetics, environmental exposures, and socioeconomic disparities.
• Sex may be a factor. MS is less common in men than in women, but male patients tend to have a more aggressive disease course and a poorer prognosis than female patients. Men also generally experience poorer recovery after relapses, show more brain atrophy over time, and become substantially disabled earlier. By contrast, women with MS tend to have fewer brain lesions with permanent nerve damage.

Future outlook: Can you live a normal life with MS?

While MS is a lifelong condition, many people with MS are able to lead fulfilling and active lives. After a diagnosis, patients should work with their healthcare team to develop a tailored plan for living with MS over the long term. This may include:

• starting a DMT soon after diagnosis to reduce relapse rates and slow disease progression
• having regular appointments with a neurologist to monitor disease activity and progression, adjusting treatment as needed
• using other medications or therapies to help manage individual symptoms
• making lifestyle changes, such as staying active, managing stress, eating well, and avoiding smoking, to improve well-being and long-term outcomes.

The course of MS varies widely. Some people experience rapid disability early on, while others may go decades without significant impact on daily life.

With modern care, most people with MS maintain a good level of mobility and independence throughout their lives. It is estimated that about two-thirds of patients retain some ability to walk 20 years after being diagnosed, though many may require aids or assisted devices such as scooters to help conserve energy.

Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.