Unveiling the Challenges of Managing MS in Diverse Populations

During the 2025 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting held in Phoenix, Arizona, leading neurologists gathered to discuss the nuanced challenges of treating multiple sclerosis (MS) across various patient demographics. The Whitaker Track's Invited Lectures session, chaired by Dr. Ahmed Zayed Obeidat, featured remarkable insights from Dr. Sam Hooshmand on the complexities of advanced MS care and how functional decline necessitates innovative treatment strategies.

The Intersection of Aging and MS

Dr. Yinan Zhang explored how aging exacerbates the effects of MS, calling attention to the increasing importance of gerotherapeutics for older patients. Meanwhile, Dr. Grace Gombolay shed light on both the advancements and ongoing challenges in pediatric MS treatment. The session concluded with an engaging panel discussion, allowing experts to collaborate on formulating tailored MS management strategies that span a patient's entire lifecycle.

Defining Advanced MS: A Clinical Challenge

Post-session, Dr. Hooshmand shared with NeurologyLive® some of the pressing issues clinicians face when recognizing and managing advanced MS. A key concern is the lack of a universally accepted definition for what constitutes 'advanced MS.' Traditionally, clinicians have depended on the Expanded Disability Status Scale (EDSS), but it primarily assesses mobility while overlooking critical factors like cognitive issues and bladder dysfunction.

Combatting Complications and Enhancing Quality of Life

Management challenges in advanced MS extend beyond initial diagnoses. Complications such as respiratory infections pose significant risks; in fact, they account for over half of infection-related deaths in this patient group. Dr. Hooshmand highlighted the necessity for healthcare providers to ask pivotal questions regarding patients' abilities to cough or swallow, as these symptoms can signal more serious issues. Additionally, urinary tract infections present dangers of sepsis, requiring vigilant observation for patients struggling to empty their bladders.

Evolving Treatment Protocols for Advanced MS

The evolution of treatment protocols for patients in advanced MS stages, particularly concerning disease-modifying therapies (DMTs), reveals a complicated landscape. Notably, pivotal clinical trials that led to current DMT approvals often exclude advanced MS patients, typically setting limitations on EDSS scores. This exclusion renders treatment discussions highly individualized, as the potential benefits and risks associated with DMTs must be carefully weighed. The focus must shift towards enhancing patients' functional independence and overall quality of life.

The Call for Inclusion in Clinical Trials

Dr. Hooshmand stressed the need for neurologists to advocate for the inclusion of advanced MS patients in clinical trials. This inclusion is crucial for generating essential data that can guide improved treatment decisions. As the field of multiple sclerosis care continues to evolve, addressing these challenges collectively will pave the way for better outcomes and quality of life for all patients.