There is some evidence to suggest that pregnancy may slow the rate of progression to predefined endpoint measures, such as walking with a stick or the onset of secondary progressive multiple sclerosis.16 The course of disease in parous women may be improved when compared with nulliparous women, although age of onset of multiple sclerosis and/or an effect on conceptive behaviour in more severely disabled women may be confounding.4 Verdu et al found that time to wheelchair use was increased by 50% where women developed multiple sclerosis before pregnancy when compared with the group who had no pregnancies after their diagnosis.17Magnetic resonance imaging (MRI) is increasingly important in the diagnosis and prognosis of multiple sclerosis. Recent trial reports have supported the use of MRI as a prognostic tool in patients presenting with their first episode of symptoms suggestive of demyelination.18,19 Eighty five per cent of patients with asymptomatic lesions, consistent with demyelination, went on to develop clinically definite multiple sclerosis. This compared with only 11% in those who had a normal scan.18 The initial lesion load also correlated with disability at 10 years.
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