Background: Multiple sclerosis is an autoimmune neurodegenerative disease of central nervous system characterized by inflammation, demyelination, as well as neuro-degeneration. The aim of the study is to detect factors affecting the degree of disability in multiple sclerosis patients for early identification and prognosis estimation. Method: Ninety relapsing remitting multiple sclerosis patients (36 males and 54 females) were included in this retrospective cohort study in the period from February 2020 to October 2022 in Zagazig University hospital and outpatient MS clinic. Full general and neurological assessments were done to all patients. Severity was evaluated by expanded disability status scale (EDSS). Physical and psychological MS impact scales were also done.MRI for brain and spine were done with gadolinium enhancement; visual evoked potential was done for the patients. Results: Among 90 patients with RRMS, 52 (57.8 %) patients had EDSS ≤3 (group A) while 38 patients (42.2%) had EDSS >3 (group B). Multilogistic regression analysis showed that black holes, total cholesterol (TC) and disease modifying therapy (DMT) use were the independent factors affecting disability in RRMS patients. There was significant positive correlation between EDSS and Visual evoked potential (VEP) latency of RT eye and there was a negative correlation between EDSS and VEP amplitude of the RT eye. Conclusions: Black holes, TC and DMT use were independent factors affecting prognosis of RRMS that help early estimation and intervention.