Recently, a patient keeps communicating with me that he or she has learned from the Internet that demyelinating diseases have a high rate of disability, that they can lead to blindness in 20 years, or paralysis, and is therefore stressed and seems to live every day in a background of fear. In my opinion, there is no need to be too pessimistic. With the advancement of science and the increase of therapeutic measures and medications, the improvement of the course of the disease and the control of the disease are no longer “extravagant” wishes, but concrete goals that can be achieved. Here is an excerpt from a review of “New Perspectives on the Natural History of Multiple Sclerosis” by a Canadian scholar. Multiple sclerosis is a slowly progressive disease that is indeed the most common neurologically disabling disease in young adults in Europe and the United States. Until the early 2000s, most people believed that 50% of patients could walk up to 100 meters within 15 to 20 years of the onset of the disease with assistance such as a cane (Disability Expansion Scale score of 6). However, reviewing a summary of the last 5 years regarding the progression of their medical history, the authors found that patients may reach an Extended Disability Scale score of 6 between 15 and 30 years after the onset of the disease (10 years extension). Relapsing-remitting and secondary-progressive multiple sclerosis. Eighty to 90 percent of patients have the relapsing-remitting type and have a disease course lasting approximately 20 years, with the possibility of later transformation to secondary progressive multiple sclerosis. In the latter type, the clinical features are indefinite relapses and very mild remissions. Primary progressive multiple sclerosis is suggested in about 15% of patients if relapses are indefinite from clinical onset or if there is only a transient small improvement. Newly published research data suggest that patients progress to a score of 6 on the Expanded Disability Scale in 6 to 20 years. patients with onset after age 50 are referred to as late-onset multiple sclerosis, and a case of an elderly patient with onset at age 81 has been reported. In contrast, primary progressive multiple sclerosis accounts for approximately 55%-80% of the late onset population. In the past 50 years, the life cycle from birth to death has increased by 20 years in humans worldwide and 13 years in Europe. The life cycle of MS patients is also increasing, but is 10 years shorter compared to the general population. Factors associated with the progression of multiple sclerosis. From previous data, the prognosis of male patients and patients with late onset disease is poor. The time to progression to a score of 6 on the Extended Disability Scale is 4 years earlier in men compared to women. Patients with relapsing-remitting type had a longer treatment time window compared to those with primary progressive type. Patients with reduced brain volume 2 years after onset had a poor prognosis. Patients with a short relapsing-remitting phase, i.e., those with an earlier transition to the secondary progressive type, had a poor prognosis. Patients with cerebrospinal fluid electrophoresis showing a lack of oligoclonal bands had a slightly better prognosis. Relapses in relation to disease progression. Patients with complete or mostly recovered clinical manifestations after the first episode had relatively slow disease progression, and those with a long interval between the first two episodes, or those with few recurrences within 5 years after onset, had a longer time to progression to disability and to transition to the secondary progressive form. 5 to 10 years before a recurrence or more than 10 years before a recurrence had no effect on disease progression. Patients with onset below 25 years of age have a greater impact on disability from relapse than those with onset above 35 years of age. Once the disease reaches the secondary progressive stage, further relapses have a weaker impact on disease progression. Relapse events later in the disease have a smaller impact on disease progression than do relapse events earlier in the disease. Benign multiple sclerosis. There are more than 10 concepts regarding benign multiple sclerosis, and the one that is well accepted is 10 years after onset and a score of Q3 on the extended disability scale. When evaluated according to this definition, about 30% of patients should have benign multiple sclerosis, especially those who present early with isolated syndrome, since the evolution from isolated syndrome to confirmed multiple sclerosis is mostly in 20 years. Malignant multiple sclerosis. The prognosis is poorer compared to benign. Malignant multiple sclerosis with genetically present HLA-DR1~01 phenotype, or 5 years after onset, with an extended disability scale score of more than 6. Note: The natural course regarding multiple sclerosis is not absolutely constant. With the increase of clinical research data, the content concept will be constantly changed, added and improved, and patients should not be pessimistic and disappointed on the basis of a half-understanding. At this stage, there are also far more drugs available for the treatment of multiple sclerosis than for neurological tumors, acromegaly, etc. Besides, scientific research is progressing and developing in many aspects such as clinical cognition, imaging, blood and cerebrospinal fluid examination methods, treatment drugs and rehabilitation techniques. If in the early stages of the disease, we are able to recognize, and actively cooperate with our doctors, and participate in interventions to prevent and reduce relapses, prolong the remission phase of relapses, and reduce demyelination and axonal destruction, you may have a benign process. And living in stress and fear can only reduce the resistance of the body, increase the number of relapses and accelerate the progression of the disease, and you may evolve a malignant process.