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. 2025 Aug 3;272(8):553.
doi: 10.1007/s00415-025-13296-6.

Advanced multiple sclerosis: an exploratory study on a neglected patient population

Omar Keritam  1   2 , Oliver Ascoli  1   2 , Andrea Harsanyi  3 , Hakan Cetin  1   2 , Thomas Berger  1   2 , Matthias Unseld  3 , Paulus Stefan Rommer  4   5
Affiliations

Advanced multiple sclerosis: an exploratory study on a neglected patient population

Omar Keritam et al. J Neurol. .

Abstract

Background: Multiple sclerosis (MS) is a chronic immune-mediated disease that can cause severe physical and cognitive disability. While modern therapies have improved outcomes in relapsing MS, patients with advanced disease remain underserved. In this stage, neurodegeneration dominates, treatment options are limited, and care becomes complex. Yet individuals with advanced MS are largely absent from trials, registries, and structured care pathways, leaving a major evidence gap.

Objectives: To characterize the clinical, social, and treatment-related profile of patients with advanced MS in institutional care.

Methods: We conducted an exploratory, retrospective study of patients with advanced MS (EDSS ≥ 6.5) admitted to a long-term care facility in Vienna. Data on disease history, comorbidities, medications, cognitive and functional status, and social background were extracted from medical records.

Results: Thirty-four patients were included (73.5% female; median age at admission: 54.1 years). Most had secondary progressive MS (85.3%). Disease-modifying therapy (DMT) exposure was limited; only one patient received DMT during care. Comorbidity and polypharmacy were frequent. EDSS progression occurred in 50%. The Braden Scale was the only score differing significantly between cohorts.

Conclusions: This study highlights care gaps in advanced MS and the need for tailored strategies in institutional care settings.

Keywords: Advanced multiple sclerosis; Co-morbidities; Palliative care; Polypharmacy.

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Conflict of interest statement

Declarations. Conflicts of interest: The authors declare no other conflict of interests. Ethical approval and patient consent: This study was approved by the ethics committee of the Medical University of Vienna (EK No. 1117/2024) in December 2023. Informed consent was obtained from patients, from whom additional historical information was collected via a case report form. Additional information: Oliver Ascoli collected the data for his diploma thesis as part of this project.

Figures

Fig. 1
Fig. 1
A, B On a group level, EDSS progressed only between T1 and T2, but not between T2 and T3. However, post-hoc analysis with the Wilcoxon matched pairs signed rank test revealed a significant difference between T2 and T3. 17 patients experienced worsening after admission to HdB. C Only one patient received a DMT after admission. During their disease course, however, 24 patients received cytostatic or immunosuppressive treatment, while 12 received glatiramer-acetate or interferon (IFN). sphingosine-1-phosphate receptor (S1PR) modulator was prescribed to only one patient. D, E The most common comorbidities were psychiatric disorders (e.g. psychoorganic syndrome, POS, dementia, or mild cognitive impairment, MCI), other neurological syndromes (e.g. seizures), and cardiovascular disease (e.g. arterial hypertension). F Most frequently prescribed medications were antihypertensive medication (n = 21), anti-seizure medication (n = 19) or antidepressants (n = 18). Additional co-medications reflect symptoms commonly associated with MS and requiring treatment. 21 patients received muscle relaxants, 13 patients received laxatives, and 7 patients received opioids
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