Research Sheds Light on Whose Multiple Sclerosis Could Worsen

The study showed that in older people with MS, fatigue and limited leg function are more often seen in those with MS progression than in those without.

“Study participants with those symptoms were more likely to progress from relapsing-remitting MS to secondary progressive MS within five years,” said Weinstock-Guttman, professor of neurology. 

“While more research needs to be done, this study brings us closer to understanding which older adults with MS may be at higher risk of getting worse,” she noted. 

“Better understanding who is at high risk of getting worse may eventually allow us to tailor more specific treatments to these people,” said Weinstock-Guttman.

“With the aging population, this information will be vital as people with MS, their families and policy makers make decisions about their care.” 

Approximately 80 to 85 percent of people with MS are initially diagnosed with relapsing-remitting MS, which is marked by symptom flare-ups followed by periods of remission. Most people eventually transition to secondary progressive MS, which does not have wide swings in symptoms but instead a slow, steady, worsening of the disease. 

While some medications have been shown to slow or even halt progression of relapsing-remitting MS, there are currently none shown to slow progression of secondary progressive MS. 

Weinstock-Guttman and her team evaluated 155 people age 50 or older who had relapsing-remitting MS for at least 15 years. The researchers made note of their symptoms and level of disability at the beginning of the study and evaluated them again five years later, at which point they had been living with MS for a median duration of 22 years.

In all, 30 percent of people in the study had progressed to secondary progressive MS by the five-year mark. 

Those who progressed to secondary progressive MS were four times as likely to report having fatigue, 92 percent compared to 68 percent of people whose disease did not progress. The results were the same after researchers adjusted for other factors that could affect disease progression, such as age, how long people had the disease and how severe their disability was. 

Those whose disease progressed were also three times as likely to have reported limitations in leg function, such as weakness and/or spasms, at the beginning of the study, 53 percent compared to 22 percent for those who didn’t progress. 

Those who progressed were older at the start of the study than those who did not progress, with an average age of 55 compared to 52. They also had a higher rate of disability at the beginning of the study as well as five years later.

First author Caila B. Vaughn, PhD, clinical assistant professor of neurology, presented the abstract in April at the 69th annual meeting of the American Academy of Neurology (AAN).

Each year, reviewers at the AAN score abstracts within categories such as “epilepsy,” “aging and dementia,” and “cerebrovascular disease and interventional neurology.”

The abstract, “Self-Reported Fatigue and Lower Limb Problems Predictive of Conversion to Secondary Progressive Multiple Sclerosis in an Aging Sample of Patients,” was rated as one of the top four abstracts in the “MS and central nervous system inflammatory disease” category.

As a result, Vaughn gave her platform presentation at a “Best Of” session that was dedicated to that category. The session featured talks by the authors of the top four abstracts, a panel discussion and a “meet the investigators” time slot.

The study was supported by the National Multiple Sclerosis Society.

Co-authors from the Department of Neurology are:

• Ralph H. Benedict, PhD, professor of neurology
• Aisha Bushra, research assistant

Ekaterina I. Noyes, PhD, research professor in the Department of Surgery, is also a co-author.

Other co-authors are from the New York State Multiple Sclerosis Consortium, the Multiple Sclerosis Center of Northeastern New York, the University of Rochester Medical Center, Stony Brook University School of Medicine, New York University Langone Medical Center, SUNY Upstate Medical University and Winthrop’s Multiple Sclerosis Treatment Center.