Here is My Question:
Could you address the issue of aging with MS. I have seen a few articles about MS slowing or hitting a plateau as we enter our sixties.
At both ends of the age spectrum--newborn and the elderly--our immune systems are relatively weaker when compared to other times in life. This is recognized as common infections, when acquired during the extremes of age, can be life threatening. In the experience of MS, which is an immune system-mediated disease, the hallmarks of inflammation (clinical relapses/attacks and new, enlarging, or contrast-enhancing scars on the MRI) tend to slow down and "plateau". This isn't the case for everyone, but on average, that is what we see.
In the event that the inflammatory stage of MS is essentially done (with no evidence of inflammation for several years), there is a good argument that the disease modifying therapies that we currently have (the ones that work on the immune system) are no longer needed. That is a discussion that should happen between the patient and physician at the appropriate time. If a joint decision is made to come off therapy, a strategy should be developed to monitor the disease to ensure that there really is no further inflammation occuring moving forward.
Unfortunately, there is a progressive phase to MS where accumulation of physical disability is evident even though there are no signs of inflammation. This is considered the "neurodegenerative" phase of MS. Not everyone goes on to this phase. It is not clear why this happens. It may be that early inflammation (in our younger years) sets the stage for neurodegeneration and progressive disability accumulation, or it may be independent of the inflammatory stage. Much interest and research is focused on this. We eagerly anticipate the development of a treatment strategy that addresses this progressive phase of MS as our current therapies have not proven capable of helping during that stage.
A. Scott Nielsen MD
Virginia Mason Multiple Sclerosis Center
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