Age is a critical determinant in recovery from multiple sclerosis relapses

• Published in: Multiple sclerosis Vol. 25; no. 13; pp. 1754 - 1763
• Main Authors: Conway, Brittani L, Zeydan, Burcu, Uygunoğlu, Uğur, Novotna, Martina, Siva, Aksel, Pittock, Sean J, Atkinson, Elizabeth J, Rodriguez, Moses, Kantarci, Orhun H
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-11-2019; Sage Publications Ltd
• Subjects: Age; Brain stem; Cerebellum; Multiple sclerosis; Multivariate analysis; Myelitis; Optic nerve; Recovery of function; Spinal cord; Multiple sclerosis; relapse; recovery; population-based cohort; fulminance; extended disability status score; age
• ISSN: 1352-4585; 1477-0970
• DOI: 10.1177/1352458518800815

Objective:
To evaluate the impact of age on recovery from multiple sclerosis relapses.
Background:
Increasing disability in multiple sclerosis is a consequence of progressive disease and incomplete relapse recovery.
Methods:
The first and last-ever relapse data (357 relapses in 193 patients) from the Olmsted County population-based multiple sclerosis cohort were systematically reviewed for age, fulminance, location (optic nerve, brainstem/cerebellar, spinal cord), peak deficit, and maximum recovery. Three different relapse-outcome measures were studied both as paired analyses and as an overall group effect: change from peak deficit to maximum recovery in raw functional system score related to the relapse (ΔFSS), a previously published FSS-based relapse-impact model, and change from peak deficit to maximum recovery in Extended Disability Status Scale (ΔEDSS) score.
Results:
Older age was linearly associated with worse recovery in the ΔFSS outcome (p = 0.002), ΔEDSS outcome (p < 0.001), and the FSS-based relapse-impact model (p < 0.001). A multivariate analysis of ΔFSS outcome linked poor recovery to older age (p = 0.015), relapse location (transverse myelitis or brainstem/cerebellar syndrome; p < 0.001), and relapse fulminance (p = 0.004).
Conclusion:
Multiple sclerosis-relapse recovery declines in a linear fashion with increased age, which should be considered when making treatment decisions.