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

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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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Data availability

Anonymized data, not published in the article, will be shared on reasonable request from a qualified investigator.

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Acknowledgements

Acknowledgments to Emilio Portaccio and Luca Prosperini for support to the realization of this study.

Funding

No funding.

Author information

Authors and Affiliations

  1. Department of Medical Sciences and Public Health, Multiple Sclerosis Center, Binaghi Hospital, University of Cagliari, ASL Cagliari, via Is Guadazzonis 2, PO Binaghi, 01916, Cagliari, Italy

    Lorena Lorefice & Eleonora Cocco

  2. Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100, Pavia, Italy

    Ottavia Elena Ferraro & Maria Cristina Monti

  3. Department of Neurosciences, ARNAS Brotzu, Cagliari, Italy

    Giuseppe Fenu

  4. Department NEUROFARBA, Section of Neurosciences, University of Florence, Florence, Italy

    Maria Pia Amato

  5. IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy

    Maria Pia Amato

  6. Department of Neurosciences, Reproductive Sciences and Odontostomatology, Multiple Sclerosis Clinical Care and Research Centre, University of Naples “Federico II”, Naples, Italy

    Vincenzo Bresciamorra

  7. Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy

    Antonella Conte

  8. IRCCS Neuromed, Pozzilli, IS, Italy

    Antonella Conte

  9. Multiple Sclerosis Centre, Neurology Unit, SS. Annunziata Hospital University “G D’Annunzio” Chieti-Pescara, Chieti, Italy

    Giovanna De Luca

  10. Department of Neurosciences, Civil Hospital of Baggiovara, AOU of Modena, Baggiovara, Italy

    Diana Ferraro

  11. Neurology, Neurorehabilitation and Neuroimaging Research Units, Neurophysiology Service, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy

    Massimo Filippi

  12. Neurology Unit, P.A. Micone Hospital, ASL3 Genovese, Genoa, Italy

    Paola Gazzola

  13. Department of Translational Biomedicine and Neurosciences, DiBraiN University of Bari Aldo Moro, Bari, Italy

    Pietro Iaffaldano

  14. Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno - Infantili (DINOGMI), Universita’ Di Genova, Genoa, Liguria, Italy

    Matilde Inglese

  15. Multiple Sclerosis Center, Second Division of Neurology, Department of Advanced Medical and Surgical Science, University of Campania Luigi Vanvitelli, 80131, Naples, Italy

    Giacomo Lus

  16. Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, 00133, Rome, Italy

    Girolama Alessandra Marfia

  17. Department Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, University of Catania, Catania, Italy

    Francesco Patti

  18. Centro Sclerosi Multipla Unità Operativa Neurologia, Azienda Unità Sanitaria Locale, Ospedale Di Vaio, Fidenza, Parma, Italy

    Ilaria Pesci

  19. Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy

    Giuseppe Salemi

  20. Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari “Aldo Moro”, 70124, Bari, Italy

    Maria Trojano

  21. Multiple Sclerosis Center, Hospital of Gallarate - ASST Della Valle Olona, Gallarate, Italy

    Mauro Zaffaroni

Authors
  1. Lorena Lorefice
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  2. Ottavia Elena Ferraro
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  6. Antonella Conte
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  7. Giovanna De Luca
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  8. Diana Ferraro
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  9. Massimo Filippi
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  13. Giacomo Lus
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  14. Girolama Alessandra Marfia
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  15. Francesco Patti
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  16. Ilaria Pesci
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  18. Maria Trojano
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  19. Mauro Zaffaroni
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  20. Maria Cristina Monti
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  21. Eleonora Cocco
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Consortia

the Italian MS Register

Contributions

Lorefice L conceptualized the study and drafted the manuscript. Ferraro O., Monti MC made the statistical analyses and drafted the manuscript. Cocco E. supervised the study, drafted and revised the manuscript. All other authors collected the data, drafted and revised the manuscript.

Corresponding author

Correspondence to Lorena Lorefice.

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All authors have nothing to disclose related to the submitted article.

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Lorefice, L., Ferraro, O.E., Fenu, G. et al. Late-onset multiple sclerosis: disability trajectories in relapsing–remitting patients of the Italian MS Registry. J Neurol 271, 1630–1637 (2024). https://doi.org/10.1007/s00415-023-12152-9

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  • DOI: https://doi.org/10.1007/s00415-023-12152-9

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