Does multiple sclerosis get worse with age? What can be done about it?

Multiple Sclerosis (MS) is a chronic disorder of the central nervous system, in which the very immune cells that protect our body from disease start attacking the myelin, a protective sheath that covers nerve fibers. Some cases of MS have a mild course with little to no disability, while in others it can become a steadily worsening disease that leads to increased disability over time. MS results in the accumulation of inflammatory lesions in the brain, spinal cord, and optic nerves.

Early symptoms of MS can vary from person to person, as it depends on the severity of the inflammatory reaction, the location, and extent of the nerve fiber damage. Early symptoms can present themselves in the form of vision problems (blurred or double vision), muscle weakness, painful muscle spasms, tingling, numbness, ache in the limbs or face, clumsiness, imbalance, dizziness, bladder issues. If the condition gets worse, the symptoms will advance to mental or physical fatigue, Depression or emotional outbursts, and even result in cognitive dysfunction — memory problems, inability to concentrate. In many advanced cases, MS can lead to partial or complete Paralysis, resulting in the patient becoming wheelchair bound.



MS usually affects people in the age range of 20 to 40yrs, but it can also develop in older adults over the age of 50yrs (late onset MS: LOMS) teens, and, in rare cases, children. LOMS accounts for 10% of all MS diagnosis. Even though this condition is not hereditary or contagious, there is a gender aspect to it. As it has been found that MS is more prevalent amongst women, with the male to female ratio being 1:4. It is mostly due to the immune system of women working differently. For e.g. as compared to men, women make less Interleukin (IL-33), an immune system protein that helps in repair of damage to nerve fibers resulting from infection/ inflammation. This explains why women are more likely to have an autoimmune disease like MS than men.

The chances of developing MS are higher in those having a history of past viral infections, such as Epstein-Barr, type 1 Diabetes, autoimmune Thyroid Disease, or Inflammatory Bowel Disease. Understanding these risk factors can help researchers find potential cures and prevention opportunities.

MS has different subsets, which have been listed below
Relapsing Remitting MS: attacks called relapses occur and symptoms get worse. Over time many relapses occur, causing significant disability. In some patients, it changes to the following type

Secondary Progressive MS: Relapses stop but patients start getting steadily worse

Primary Progressive MS: In this type, symptoms gradually get worse without any obvious relapses or remissions

All types of MS can get worse with time. Worsening of MS often occurs with time, especially without an effective ongoing disease modifying treatment. As life expectancy and MS treatments continues to improve, people with MS are living longer. it is not unusual to see an elderly with symptoms of MS mixed with those due to other age-related neurodegenerative disorders such as Alzheimer’s dementia and Parkinson’s disease.

(Author: Dr Pawan Ojha, Director of Neurology, Fortis Hiranandani Hospital, Vashi)