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Advanced multiple sclerosis: an exploratory study on a neglected patient population.

Omar Keritam1,2, Oliver Ascoli1,2, Andrea Harsanyi3

  • 1Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.

Journal of Neurology
|August 3, 2025
PubMed
Summary

Patients with advanced multiple sclerosis (MS) in long-term care face significant challenges, including limited treatment options and frequent comorbidities. This study reveals critical care gaps, emphasizing the need for specialized strategies in institutional settings for this underserved population.

Keywords:
Advanced multiple sclerosisCo-morbiditiesPalliative carePolypharmacy

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Area of Science:

  • Neurology
  • Immunology
  • Geriatric Care

Background:

  • Multiple sclerosis (MS) is a chronic, immune-mediated neurological disease causing progressive disability.
  • Current therapies are effective for relapsing MS but advanced stages with neurodegeneration remain underserved.
  • Patients with advanced MS are underrepresented in research and structured care pathways, creating an evidence gap.

Purpose of the Study:

  • To characterize the clinical, social, and treatment profiles of patients with advanced MS in institutional care.
  • To identify unmet needs and care gaps in this specific patient population.

Main Methods:

  • An exploratory, retrospective study was conducted on patients with advanced MS (Expanded Disability Status Scale [EDSS] ≥ 6.5) in a long-term care facility.
  • Data extracted from medical records included disease history, comorbidities, medications, cognitive/functional status, and social background.
  • Thirty-four patients were included, with a median age of 54.1 years at admission.

Main Results:

  • The majority of patients had secondary progressive MS (85.3%) and were female (73.5%).
  • Disease-modifying therapy (DMT) use was very limited during institutional care.
  • Comorbidities and polypharmacy were common, and 50% experienced EDSS progression.

Conclusions:

  • This study underscores significant care gaps for individuals with advanced MS in institutional settings.
  • There is a critical need for developing and implementing tailored care strategies for advanced MS patients in long-term care facilities.