How has the age of onset for relapsing-remitting multiple sclerosis changed over five decades. What factors contribute to the increasing age of MS onset. Why is understanding MS onset age important for diagnosis and treatment.

The Shifting Landscape of Multiple Sclerosis Onset Age

Multiple sclerosis (MS) is a complex neurological disorder that has intrigued researchers and clinicians for decades. One of the most significant aspects of MS that has garnered attention is the age at which symptoms first appear. A groundbreaking study conducted by researchers at the Hospital Universitari de Bellvitge in Barcelona, Spain, has shed new light on this crucial factor.

The study, led by Lucía Romero-Pinel and colleagues, investigated how the age of onset for relapsing-remitting multiple sclerosis (RRMS) has evolved over the past 50 years. Their findings challenge the long-held belief that MS primarily affects young adults between 20 and 40 years of age.

Key Findings of the Study

• The research spanned from January 1970 to December 2019
• Patients were divided into five groups based on the decade of symptom onset
• The study included patients diagnosed with RRMS using either Poser or McDonald criteria
• Age at disease onset was compared across decades
• Additional analyses excluded patients with early-onset (<18 years) and late-onset disease

Unraveling the Trend: Increasing Age of MS Onset

The research team’s meticulous analysis revealed a startling trend: the average age at which individuals experience their first symptoms of RRMS has been steadily increasing over the past five decades. This finding challenges the traditional understanding of MS as a disease that primarily affects young adults.

Is there a significant difference in onset age between decades? The study’s results indicate a clear upward trend in the age of onset for RRMS. While specific numbers were not provided in the abstract, the researchers’ conclusion strongly suggests that the difference is statistically significant and clinically relevant.

Implications of Later Onset

1. Diagnostic challenges for healthcare providers
2. Potential changes in disease progression and prognosis
3. Adjustments needed in treatment strategies
4. Impact on patient quality of life and career planning
5. Modifications required in public health policies and resource allocation

Factors Contributing to the Increasing Age of MS Onset

The observed trend of increasing age at MS onset is likely influenced by a complex interplay of various factors. While the study does not explicitly detail these factors, several possibilities can be inferred based on current knowledge in the field of MS research.

Environmental Influences

How might environmental changes contribute to later MS onset? Environmental factors play a crucial role in MS development, and changes over the past decades could influence the age of onset:

• Increased awareness of vitamin D deficiency and supplementation
• Changes in smoking habits and exposure to secondhand smoke
• Shifts in dietary patterns and nutrition
• Alterations in exposure to infectious agents
• Changes in air quality and pollution levels

Genetic Considerations

Do genetic factors play a role in the changing age of MS onset? While genetic predisposition is a known risk factor for MS, the rapid change observed over just five decades suggests that genetic shifts alone are unlikely to explain the trend. However, gene-environment interactions could be contributing to the later onset:

• Epigenetic modifications influenced by environmental factors
• Changes in gene expression patterns over time
• Potential influence of generational genetic variations

Diagnostic Advancements and Their Impact on MS Onset Age

The evolving landscape of MS diagnosis has undoubtedly played a role in the observed trend of increasing onset age. Advanced diagnostic techniques and revised criteria have significantly impacted how and when MS is identified.

Evolution of Diagnostic Criteria

How have changes in diagnostic criteria affected the perceived age of MS onset? The study mentions the use of both Poser and McDonald criteria, which have undergone several revisions over the years:

• Poser criteria (1983): Focused on clinical and paraclinical evidence
• McDonald criteria (2001): Incorporated MRI findings
• Revised McDonald criteria (2005, 2010, 2017): Refined MRI usage and simplified diagnosis

These evolving criteria have allowed for earlier and more accurate diagnosis, potentially identifying cases that might have been missed in earlier decades.

Technological Advancements

What role do technological improvements play in detecting MS? The advent and refinement of various diagnostic tools have revolutionized MS detection:

• Magnetic Resonance Imaging (MRI): Increased availability and improved resolution
• Cerebrospinal Fluid (CSF) analysis: Enhanced techniques for detecting oligoclonal bands
• Optical Coherence Tomography (OCT): Non-invasive imaging of the retina and optic nerve
• Evoked Potentials: Refined methods for assessing nerve conduction

These advancements may have led to the identification of MS in older individuals who might have been misdiagnosed or overlooked in previous decades.

Clinical Implications of Later MS Onset

The trend towards later onset of RRMS has significant implications for clinical practice, patient management, and healthcare policy.

Disease Course and Prognosis

How does later onset affect the course of MS? The age at which MS symptoms first appear can influence the disease trajectory:

• Potentially slower progression in later-onset cases
• Altered immune responses in older individuals
• Interaction with age-related neurological changes
• Impact on cognitive function and physical disability

Treatment Considerations

What adjustments are needed in MS treatment strategies for later-onset cases? The shift in onset age necessitates a reevaluation of current treatment approaches:

• Tailoring disease-modifying therapies for older patients
• Consideration of comorbidities more common in older adults
• Balancing treatment efficacy with potential side effects in an aging population
• Emphasis on personalized medicine approaches

Public Health and Socioeconomic Implications

The changing landscape of MS onset age has far-reaching consequences beyond the clinical realm, affecting public health policies and socioeconomic factors.

Healthcare Resource Allocation

How should healthcare systems adapt to the trend of later MS onset? The shift in onset age requires a reconsideration of resource allocation:

• Adjusting neurological services to accommodate older MS patients
• Integration of MS care with geriatric services
• Enhanced focus on managing MS alongside age-related conditions
• Reevaluation of long-term care needs for MS patients

Socioeconomic Impact

What are the societal implications of later MS onset? The changing onset age affects various aspects of patients’ lives and society at large:

• Potential extension of working years before disability onset
• Changes in retirement planning and financial considerations
• Impact on family planning and caregiving responsibilities
• Alterations in disability benefit structures and policies

Future Directions in MS Research and Care

The findings of this study open up new avenues for research and necessitate a reevaluation of current approaches to MS care and management.

Research Priorities

What key areas should future MS research focus on in light of these findings? The trend of increasing onset age highlights several critical research directions:

• Investigating the underlying causes of later MS onset
• Exploring age-specific biomarkers for MS diagnosis and prognosis
• Developing and testing treatments tailored for older-onset MS patients
• Longitudinal studies to track long-term outcomes in later-onset cases
• Examination of potential protective factors delaying MS onset

Clinical Practice Adaptations

How should clinical practice evolve to address the changing MS landscape? Healthcare providers and institutions need to adapt their approaches:

• Enhanced training for neurologists in managing older-onset MS cases
• Development of age-specific clinical guidelines for MS diagnosis and treatment
• Implementation of multidisciplinary care teams to address complex needs of older MS patients
• Increased focus on patient education and support for later-life MS diagnosis

The groundbreaking study by Romero-Pinel and colleagues has unveiled a significant shift in the onset age of relapsing-remitting multiple sclerosis over the past five decades. This finding challenges long-held assumptions about MS and has far-reaching implications for diagnosis, treatment, and patient care. As the medical community grapples with this new understanding, it becomes clear that a paradigm shift in MS research and management is necessary.

The increasing age of MS onset presents both challenges and opportunities. While it may complicate diagnosis and treatment strategies, it also opens up new avenues for research into the underlying mechanisms of MS and potential protective factors that delay disease onset. The trend underscores the need for personalized medicine approaches and highlights the importance of considering age-related factors in MS care.

As we move forward, it is crucial for healthcare systems, policymakers, and researchers to adapt to this changing landscape. By doing so, we can ensure that patients with later-onset MS receive optimal care and support, ultimately improving outcomes and quality of life for those affected by this complex neurological disorder.

The journey to fully understand and effectively manage multiple sclerosis continues, with each new discovery bringing us closer to unraveling its mysteries. The findings of this study serve as a reminder that our understanding of diseases is constantly evolving, and we must remain vigilant and adaptable in our approach to research and patient care.

The age at onset of relapsing-remitting multiple sclerosis has increased over the last five decades

. 2022 Dec;68:104103.

doi: 10.1016/j.msard.2022.104103.

Epub 2022 Aug 9.

Lucía Romero-Pinel 
¹
, Laura Bau 
²
, Elisabet Matas 
²
, Isabel León 
²
, Albert Muñoz-Vendrell 
²
, Pablo Arroyo 
²
, Cristina Masuet-Aumatell 
³
, Antonio Martínez-Yélamos 
⁴
, Sergio Martínez-Yélamos 
⁴

Affiliations

Affiliations

• ¹ Multiple Sclerosis Unit, Department of Neurology. Hospital Universitari de Bellvitge – IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain. Electronic address: [email protected].
• ² Multiple Sclerosis Unit, Department of Neurology. Hospital Universitari de Bellvitge – IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain.
• ³ Department of Epidemiology and Preventive Medicine. Hospital Universitari de Bellvitge – IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain.
• ⁴ Multiple Sclerosis Unit, Department of Neurology. Hospital Universitari de Bellvitge – IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain; Departament de Ciències Clíniques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain.

• PMID:

  36029708

• DOI:

  10. 1016/j.msard.2022.104103

Free article

Lucía Romero-Pinel et al.

Mult Scler Relat Disord.

2022 Dec.

Free article

. 2022 Dec;68:104103.

doi: 10.1016/j.msard.2022.104103.

Epub 2022 Aug 9.

Authors

Lucía Romero-Pinel 
¹
, Laura Bau 
²
, Elisabet Matas 
²
, Isabel León 
²
, Albert Muñoz-Vendrell 
²
, Pablo Arroyo 
²
, Cristina Masuet-Aumatell 
³
, Antonio Martínez-Yélamos 
⁴
, Sergio Martínez-Yélamos 
⁴

Affiliations

• ¹ Multiple Sclerosis Unit, Department of Neurology. Hospital Universitari de Bellvitge – IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain. Electronic address: [email protected].
• ² Multiple Sclerosis Unit, Department of Neurology. Hospital Universitari de Bellvitge – IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain.
• ³ Department of Epidemiology and Preventive Medicine. Hospital Universitari de Bellvitge – IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain.
• ⁴ Multiple Sclerosis Unit, Department of Neurology. Hospital Universitari de Bellvitge – IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain; Departament de Ciències Clíniques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain.

• PMID:

  36029708

• DOI:

  10. 1016/j.msard.2022.104103

Abstract

Background:

Patients with relapsing-remitting multiple sclerosis (RRMS) most commonly experience their first symptoms between 20 and 40 years of age. The objective of this study was to investigate how the age at which the first symptoms of RRMS occur has changed over the past decades.

Methods:

Patients who were followed up in our unit after an initial diagnosis of RRMS using the Poser or McDonald criteria and who experienced their first symptoms between January 1970 and December 2019 were included in the study. The cohort was divided into five groups according to the decade in which the first symptoms appeared. The age at disease onset was compared across decades. Changes in age were also determined after excluding patients with early-onset disease (<18 years of age) and those with late-onset disease (>50 years of age) to avoid bias.

Results:

The cohort included 1,622 patients with RRMS, 67.6% of whom were women. Among them, 5.9% and 4% had early-onset and late-onset disease, respectively. The mean age ± standard deviation at onset was 31.11 ± 9.82 years, with no differences between men and women. The mean ages at onset were 23.79 ± 10.19 years between 1970 and 1979, 27.86 ± 9.22 years between 1980 and 1989, 30.07 ± 9.32 years between 1990 and 1999, 32.12 ± 9.47 between 2000 and 2009, and 34.28 ± 9.83 years between 2010 and 2019. The ages at disease onset were progressively higher in the later decades; this trend was statistically significant (p < 0.001), with a Pearson linear correlation coefficient R of 0.264 and R² of 0.070 (p < 0.001). The results were similar when analysing men and women separately. We conducted an analysis of 1,460 patients (mean age at onset: 31.10 ± 7.99 years), after excluding patients with early-onset and late-onset disease. In this specific subgroup, the mean ages at disease onset were 28.38 ± 8.17 years between 1970 and 1979, 29.22 ± 7.51 years between 1980 and 1989, 30.06 ± 8.02 years between 1990 and 1999, 31.46 ± 7.77 years between 2000 and 2009, and 33.37 ± 7.97 years between 2010 and 2019. The trend was also statistically significant (p < 0.001), with a Pearson linear correlation coefficient R of 0.193 and R² of 0.037 (p < 0.001).

Conclusion:

Our data showed that the age at RRMS onset has increased over the past decades.

Keywords:

Age at onset; Disease course; Epidemiology; Multiple sclerosis; Relapsing-remitting.

Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.

Conflict of interest statement

w3.org/1998/Math/MathML” xmlns:p1=”http://pubmed.gov/pub-one”>Declaration of Competing Interest Lucía Romero-Pinel, Laura Bau, Elisabet Matas, Isabel León, Albert Muñoz-Vendrell, Pablo Arroyo, Antonio Martínez-Yélamos, and Sergio Martínez-Yélamos received honoraria for participating on advisory boards and for collaborations as consultants and scientific communications; they also received research support as well as funding for travel and congress-attending expenses from Roche, Biogen Idec, Novartis, TEVA, Merck, Genzyme, Sanofi, Bayer, Almirall, and Celgene. Cristina Masuet-Aumatell received honoraria for participating on advisory boards and for collaborations as a consultant and scientific communications and has received research support as well as funding for travel and congress-related expenses from GlaxoSmithKline, Pfizer, Seqirus, Emergent and Sanofi Pasteur.

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MeSH terms

Multiple Sclerosis in People Over Age 55

Multiple sclerosis (MS) is a chronic inflammatory disease that affects the central nervous system (CNS) and is characterized by inflammation and demyelination resulting in neurologic disability that may be irreversible. It is considered the most common cause of non-traumatic neurologic disability in adults.¹ Historically, MS was recognized as a disease of young people as the typical onset is between age 20 to 40 years.² The life expectancy of the general population, however, is increasing. Additionally, advances in MS treatment have led to an increase in the average age of persons with MS. ³ Thus, MS can no longer be considered a disease of earlier adulthood only because clinicians will be treating people with MS into their later decades of life. Simultaneous management of aging and MS is among the current unmet needs in MS care, considering the unclear phenotypes, disease course, associated comorbidities, aging of the immune system (immunosenescence), MRI characteristics, response to disease-modifying therapies (DMTs), and disease progression. In this review, we address several issues pertinent to the care of people with MS in a person’s mid50s and beyond, discussing the epidemiology of MS in this population, immunosenescence, use of DMTs, and, finally, cognitive impairment.

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Epidemiology of MS After Age 55

Multiple sclerosis affects persons of all ages. Age is a predictor of MS phenotypes and onset of relapsing MS (RMS) between age 20 to 40 years accounts for 80% of cases. Secondary progressive MS (SPMS) is considered the long-term outcome of RMS, but more than 30% of people with MS continue to have RMS at an advanced age. ⁴ Only 3.4% of people with MS are diagnosed with RMS after age 50, considered late-onset MS, and only 1% are diagnosed after the age 60, considered very late-onset MS.²

In contrast, the primary progressive MS (PPMS) phenotype tends to present after age 45 and accounts for 10% to 15% of cases. PPMS is characterized by a slow neurologic decline from onset.⁵ Yet, the overall demographics of people with MS are changing to include people in their mid50s and later. For example, in Manitoba, Canada, the reported prevalence of MS has increased from 32.6 per 100,000 in 1984 to 226 per 100,000 in 2006, with evidence of increased age of peak prevalence from 35 to 39 years to 55 to 59 years.⁶ Similarly, in Italy, 18% of people with MS are age 65 or more.⁷ Thus, the care of people age 55 and more is becoming part of routine practice in MS clinics. Whether people with MS who first present later in life have a different phenotype is not yet well studied.

Immunosenescence

Aging is well known to be associated with progressive loss of innate and adaptive immune system proficiency and an adequate immune response (immunosenescence). These changes have many implications for people with MS.⁸ It has been suggested that there are 2 parallel inflammatory processes during the course of MS that manifest as the relapsing and progressive MS phenotypes. In simple terms, the first is invasion of the brain by T and B lymphocytes through a blood-brain barrier damaged by inflammation, presenting as clinical relapses and active demyelination. The second is a slow accumulation of B and T cells in the meninges without major blood-brain-barrier breakdown, forming aggregate or lymphoid follicles, which cause a slow inflammatory process and neurodegeneration, resulting in a progressive phenotype. These latter changes may present early in the course of MS but become more predominant at late stages.⁹

In the early stages of MS, typically occurring at age 20 to 40 years, the immune system is more functional, with repair capacity that is more effective in healing the inflammatory damage. With aging, the immune system repair capacity decreases, and axonal degeneration, iron deposition, and oxidative stress occur, leading to decreased natural brain reserve. This gradual decrease in healing and brain reserve might partly explain the progression of MS seen with aging.¹⁰ The difference between the immune response in the early stage of RMS compared with progressive MS may also explain why evidence of reduced disability and disease progression has not been shown for most DMTs, based on probable different mechanisms of disease activity for relapse vs progression.¹¹

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It also has been suggested that aging is associated with low-grade inflammatory processes resulting from previous viral infections (eg, cytomegalovirus or Epstein-Barr virus) over the lifespan. This phenomenon is called inflamm-aging and results in accumulation of senescent immune cells that are no longer able to play a role in the tissue repair process. Senescent immune cells are thought instead to produce a continuous slow inflammatory process and secrete proinflammatory growth factors, cytokines, and antibodies. This shift to a proinflammatory state would also contribute to further damage rather than tissue repair and, hence, gradual functional decline. Based on this observation, antiaging strategies might be a future focus in that decreasing inflammaging without affecting normal physiologic inflammatory processes could thereby increase survival and slow disability progression.¹²

Disease-Modifying Therapy

Our knowledge regarding DMTs in people over age 55 with MS, regardless of the type of MS, is still minimal and further studies are warranted to better understand when these medications should be discontinued. To date, few studies have assessed the efficacy and safety of DMTs in people over age 55, with only a few clinical trials including this population. Yet, the number of persons with MS in this age group is increasing, and progressive MS is more common in those over age 65. ³ Among the few studies to include people over age 55 was a retrospective study assessing the efficacy of interferon β-1b in people with MS over age 50; however, the study did not demonstrate a significant decrease in disability in those over age 50 on follow-up.¹³ A subgroup analysis of a double-blind randomized placebo-controlled trial assessing the efficacy of fingolimod compared with placebo in people with MS more than age 40 did not show a significant difference in the annualized relapse rate (ARR).¹⁴ Overall, our knowledge regarding the efficacy and safety of DMTs in people with MS more than age 55 is limited, and further studies are needed.

There are now 2 DMTs approved to treat progressive MS. Ocrelizumab is approved for PPMS,¹⁵ although people over age 55 were excluded from the phase 3 trial of ocrelizumab. Siponimod is approved for SPMS, although the upper age limit for inclusion in clinical trials of siponimod was 60.¹⁶ An open-label study of the efficacy and safety of ocrelizumab in persons with progressive MS inclusive of people up to age 65 years is ongoing. ^a The reasons for excluding people with MS who are over age 55 from most clinical trials are not well addressed but might be due to a multitude of factors, including previous underestimation of MS prevalence in this population, the decrease in inflammation with age and immunosenescence in MS, associated comorbidities that might affect planned study outcomes, and concern about the safety and efficacy of DMTs in this population with other comorbidities. In a meta-analysis of 45 clinical trials age-related risk of infection and neoplasms associated with DMTs was evaluated. By comparing DMT mechanisms of action, the analysis found increased risk of neoplasms with increasing age while on immunodepleting DMTs, with no clear evidence of an age-related increase in infection risk.¹⁷ In contrast, another study showed evidence infection risk and infection-related mortality increased with age in individuals who were being treated with immunomodulatory and immunosuppressive MS agents, which might reflect again the interaction between Immunosenescence and DMT use. ⁸

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Cognitive Impairment

Cognitive impairment (CI) is common in MS, with a prevalence of 40% to 65%. CI can occur at any stage of MS, starting at radiologically isolated syndrome (RIS), but onset of CI has been noted at all stages of MS. CI in MS can affect attention, episodic memory, information processing speed, and executive functions. CI can be extremely debilitating for people with MS, with substantial negative effects on activities of daily living.¹⁸

The characteristics and type of CI may differ among MS phenotypes. A cross-sectional study used a large battery of neuropsychologic tests to assess affected domains of cognition in people with PPMS vs RMS. Those with PPMS had more impairment in information processing speed, attention, executive function, and working and episodic memory, whereas those with RMS group had impairment predominantly in information processing speed and working memory.¹⁹

In a 10-year longitudinal study of cognitive function in persons with MS (n=50), prevalence of CI increased from 26% to 49% during the first 4 years. By the end of the study, 56% of participants had mild-to-moderate CI, supporting the concept that MS-related progression and prevalence of CI increases as the duration of MS increases.²⁰

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CI in MS and the relationship of CI in MS to aging and physical disability were investigated in a large study of prevalence and phenotypes of CI in people with MS (n=1,040) with different phenotypes and stages of MS. Increasing age and disease duration were found to be the main determinants of CI. Additionally, people with either PPMS or SPMS had twice the risk of CI compared with those who had RMS or clinically isolated syndrome.²¹

Classically, MS-related CI does not present with aphasia, apraxia, or anomia and thus is a distinct phenotype from other dementias. Among the challenges of diagnosing CI in people over age 55 with MS is whether the cognitive dysfunction being assessed is part of the Alzheimer disease (AD)

spectrum, including prodromal amnestic mild cognitive impairment (AMCI), or is MS-related CI alone. A study used neuropsychologic measures used in diagnosing AD (ie, the Logical Memory subtest of the Wechsler Memory Scale for verbal episodic memory, semantic fluency for verbal fluency, Boston Naming Test for confrontation naming, and the sorting test from the Delis Kaplan Executive Function System (D-KEFS) for executive function) and found distinct cognitive profiles that differed between MS and AD and AMCI, suggesting these are distinct from each other, with only some overlap in semantic fluency deficiency among those with MS and AMCI.²²

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Conclusion

MS today is no longer only a disease of early adulthood, regardless of age of onset and MS phenotype. The prevalence of people with MS over age 55 is increasing; their unique presentations should not be overlooked. It seems that immune system aging plays a role in the course of MS. As we age, the immune system does as well, resulting in an immune system with less ability to adequately respond and repair. This increased prevalence of dysregulated immune responses may explain some characteristics of that change with age. The available data regarding DMTs in people with MS over age 55 remains sparse because most clinical trials excluded this population. Further studies in this age group are warranted.

Finally, other factors in this age group must be considered, such as associated comorbidities, aging of the immune system (immunosenescence), response to DMTs, disease progression, and cognitive impairment, when addressing the treatment and ongoing care of persons with MS over age 55.

a. An Open-Label, Single-Arm 4-Year Study to Evaluate Effectiveness and Safety of Ocrelizumab Treatment in Patients With Progressive Multiple Sclerosis (NCT03523858)

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AAKB and SAM report no disclosures

A disease of the young and talented – neurologist O.

A. answers questions about multiple sclerosis. Soldatova

According to WHO, the third place among diseases of the central nervous system is occupied by multiple sclerosis (after vascular diseases and epilepsy). Today we will talk about the 10-year work of the Center for Consultative Assistance to Patients with Multiple Sclerosis of the CDC, with an experienced neurologist Olga Anatolyevna Soldatova:

– When, to whom and for what purpose did the idea come up to create a Center for Consultative Assistance to Patients with Multiple Sclerosis?

О.А.: The Center was established on the basis of the Omsk Clinical Diagnostic Center in 2010, but the idea of ​​its origin was born in the last century, when we began to deal with demyelinating diseases (V.N. Bagir and V.G. Shmatko were the initiators of the development of this direction in Omsk, I came as an intern, studied and eventually stayed for 20 years). In 2008, patients with multiple sclerosis organized the Society of Multiple Sclerosis Patients, it was they who made a request to organize a specialized center. The diagnostic center was chosen as a clinical base, since all the necessary conditions were collected here in one place. 10 years have passed, our capabilities have increased over time, our knowledge has expanded, and we sincerely hope that we were able to meet the expectations of our patients and show decent results. The main task of the Center for Consultative Assistance to Patients with Multiple Sclerosis is to concentrate all knowledge, resources and opportunities to provide quality and affordable medical care to patients, to improve their quality of life.

– How common is this disease today? How many patients with multiple sclerosis in our region?

О.А.: More than 100 thousand people suffer from multiple sclerosis in Russia, more than 1000 patients are registered in the Omsk region. The average prevalence of the disease is about 60 people per 100,000 population.

The incidence of multiple sclerosis and autoimmune disease is generally increasing worldwide. This is due, among other things, to the development of diagnostic capabilities at the earliest stages. Multiple sclerosis is one of the most common causes of persistent disability in young people.

– Is multiple sclerosis incurable?

OA: We don’t use the term “incurable disease”, it’s a very pessimistic description. Multiple sclerosis is included in the group of chronic progressive diseases. But it is important to emphasize that today this disease is curable, that is, it is treatable, it can be effectively controlled, which allows patients to maintain an active life and work capacity for a long time. In this disease, early diagnosis is important, because we have the opportunity to minimize the progression of the disease and stabilize the patient at the stage at which we met with him, established the diagnosis and began treatment.

– Is multiple sclerosis considered a disease of the young? At what age does it most often appear?

О. А.: According to statistics, the onset of the disease occurs at the age of 16-35 years, rarely in childhood and over 50 years of age. On average, the disease most often manifests itself in 25-30 years. Therefore, multiple sclerosis is truly a “disease of the young.”

– What are the symptoms of this disease?

OA: The difficulty is that multiple sclerosis has no specific symptoms. Most often there are visual impairments (especially in one eye) at the onset of the disease, unsteadiness, weakness, and numbness may also appear. In the literature there are various popular names for multiple sclerosis – “monkey of all diseases”, “a disease with a thousand faces”. Therefore, the diagnosis of multiple sclerosis is a very complex and lengthy process; the diagnosis, like a puzzle, consists of many components. For diagnostics, all modern research methods are used, including MRI, laboratory and functional diagnostics.

– When you come to see you for the first time, does it mean that you continue to see patients for the rest of your life?

О. А.: Yes, as a rule, I see patients constantly from the moment they apply, in the process I get to know their families, I know the life situation of almost every of my regular patients. I also maintain a separate register of pregnant women – more than 50 young women with multiple sclerosis have already been able to endure and give birth to children.

– How difficult is it for people to accept their diagnosis?

OA: Of course, the psychological aspect is very important. It is often difficult for young people to accept their illness on a psychological level. They read information in open sources and until the last moment they are not ready to apply it to themselves. We try to convince of the importance of starting treatment at the initial stage in order to preserve the quality of life to which he is accustomed for as long as possible. However, we are not omnipotent, the type of course of the disease, which is genetically determined, is of great importance.

– If the disease cannot be completely cured, what can be considered a good result?

О.А.: We start treatment from the moment when the diagnosis is made, our main task is to stay at this level, if we manage to do this for many years, then this is a good result. In general, a stable state without clinical manifestations of the pathological process is the main goal we are striving for. At the end of the conversation, I would like to wish the patients health and optimism, faith in themselves and in us!

Interesting facts:

*** The older generation knows about multiple sclerosis from the life of the writer Nikolai Ostrovsky, the author of the famous work “How the Steel Was Tempered” – he fell ill and died at a young age. Previously, indeed, this diagnosis was a threat of disability at a young age. Smart, talented, educated youth completely fell out of life, so multiple sclerosis is also called “the disease of the young and talented. ” But it is worth saying that over the past decades there has been a very serious progress in the treatment of the disease, effective drugs have been developed and put into practice – the World Health Organization has recognized this as one of the highest achievements of modern medicine.

*** In the middle of the last century, the famous American neurologist John Kurtzke counted 685 symptoms of multiple sclerosis, and none of them is characteristic of this particular disease.

symptoms, early signs and treatment

In the past century, multiple sclerosis was thought to affect adults, mostly women. However, at the end of the 20th century and already in the 21st century, cases of multiple sclerosis in children are convincingly shown. Epidemiological studies have shown that 3 to 10% (average about 5%) of the onset of multiple sclerosis occurs before the age of 16, predominantly in the age group of 13-16 years and less than 1% before the age of 10 years.

The course of multiple sclerosis in childhood has a number of differences, for example, only 2% of patients develop a primary progressive type (PPMS) course, in contrast to the adult population, where PPMS affects from 10 to 15% of people. The debut is usually more violent, with severe disorders of various functions of the nervous system: vision, movement, sensitivity, coordination. Often the debut is manifested by acute disseminated encephalomyelitis. At the same time, children recover better, usually no symptoms persist after the exacerbation is treated. It is believed that good recovery is due to a more plastic central nervous system with a large reserve of compensation. In children, exacerbations occur more often, and there is also a large number of foci of demyelination from the very beginning of MS. But in general, if we trace the development of MS in people with the onset of the disease in childhood, the accumulation of disability is slower, significantly more years pass before the transition to the secondary progressive type. On the other hand, since the disease began earlier, the age of transition to SPMS is still earlier than in adult patients.

Diagnosis of MS in children

Diagnosis of multiple sclerosis in children requires the exclusion of a large list of diseases, including hereditary diseases, infections, mitochondrial encephalopathy and other conditions that show up as focal changes on MRI.