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03-01-2024 | Multiple Sclerosis | Original Communication

Late-onset multiple sclerosis: disability trajectories in relapsing–remitting patients of the Italian MS Registry

Authors: Lorena Lorefice, Ottavia Elena Ferraro, Giuseppe Fenu, Maria Pia Amato, Vincenzo Bresciamorra, Antonella Conte, Giovanna De Luca, Diana Ferraro, Massimo Filippi, Paola Gazzola, Pietro Iaffaldano, Matilde Inglese, Giacomo Lus, Girolama Alessandra Marfia, Francesco Patti, Ilaria Pesci, Giuseppe Salemi, Maria Trojano, Mauro Zaffaroni, Maria Cristina Monti, Eleonora Cocco, the Italian MS Register

Published in: Journal of Neurology | Issue 4/2024

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Abstract

Background

Generally infrequent, multiple sclerosis (MS) with late onset (LOMS) is characterized by an onset over the age of 50 and a mainly progressive course, while relapsing–remitting (RR) forms are less frequently observed and explored. This study aimed to characterize a large cohort of MS patients with RRMS at onset to assess the baseline factors related to the worst disability trajectories and explore the role of LOMS.

Methods

The data were extracted from the Italian MS Register (IMSR). Disability trajectories, defined using at least two and up to twenty expanded disability status scale (EDSS) assessments annually performed, were implemented using group-based trajectory models (GBTMs) to identify different groups with the same trajectories over time. MS profiles were explored using multinomial logistic regression.

Results

A total of 16,159 RR patients [1012 (6.26%) presented with LOMS] were analyzed. The GBTM identified four disability trajectories. The group with the most severe EDSS trend included 12.3% of the patients with a mean EDSS score > 4, which increased over time and exceeded 6 score. The group with medium severity EDSS trend comprised 21.9% of the patients and showed a change in EDSS > 3 scores over time. The largest group with 50.8% of patients reported a constant EDSS of 2 score. Finally, the benign group comprised 14.9% of the patients with a low and constant EDSS of 1 score over time. The probability of being in the worst groups increased if the patient was male; had LOMS or experienced brainstem, spinal, or supratentorial symptoms.

Conclusions

Four MS severity profiles among RRMS patients in the IMSR have been reported, with LOMS being associated with a rapid worsening of EDSS scores. These findings have important implications for recognizing and managing how older age, aging, and age-related factors interact with MS and its evolution.
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Metadata
Title
Late-onset multiple sclerosis: disability trajectories in relapsing–remitting patients of the Italian MS Registry
Authors
Lorena Lorefice
Ottavia Elena Ferraro
Giuseppe Fenu
Maria Pia Amato
Vincenzo Bresciamorra
Antonella Conte
Giovanna De Luca
Diana Ferraro
Massimo Filippi
Paola Gazzola
Pietro Iaffaldano
Matilde Inglese
Giacomo Lus
Girolama Alessandra Marfia
Francesco Patti
Ilaria Pesci
Giuseppe Salemi
Maria Trojano
Mauro Zaffaroni
Maria Cristina Monti
Eleonora Cocco
the Italian MS Register
Publication date
03-01-2024
Publisher
Springer Berlin Heidelberg
Published in
Journal of Neurology / Issue 4/2024
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-023-12152-9

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