When patients with multiple sclerosis (MS) attend specialist clinics, questions regarding individual prognosis are often the most difficult to answer as available data are necessarily derived from large cohort studies. Common enquiries include the chances of developing MS after an isolated clinical episode, whether the patient has entered a progressive disease phase, and the likelihood of a future relapse occurring. Since MS displays a wide phenotypic clinical spectrum, clinicians have to draw on experience derived from individual patient presentation, as well as best available evidence to provide effective counselling. As a result, predicting future outcomes in patients remains an active area of research and may also reveal interesting insights into disease pathogenesis. In the first paper reviewed this month, investigators from Denmark studied blood–brain barrier (BBB) permeability in patients presentingwith optic neuritis and consideredwhether changes in both the normal-appearing white matter and grey matter could help predict future development of MS. As well as providing a novel imaging approach to prognostication, this study also revealed some interesting pathological findings. The second paper presents data on potential novel biomarkers, whilst again revealing some surprising results with regard to the pathophysiology of progressive disease. The last paper is perhaps of more immediate clinical value. Since a large proportion of patients with MS are women of childbearing age, questions surrounding management in pregnancy and during the postpartum period are regularly addressed. In this study, the authors have focused on the effect of breastfeeding on postpartum relapse, the results of which may influence how clinicians advise patients during this emotive time.