How to prevent severe multiple sclerosis in the elderly?

Question

Hello doctor,

My grandfather is 60 years old, was recently diagnosed with aggressive Multiple sclerosis, and we are feeling completely lost. He is experiencing rapid mobility issues and muscle weakness that seems to progress quickly. One month, he was walking with a cane, and now he is mostly confined to a wheelchair. The family is stressed about how fast the condition is advancing. We have heard MS can have different progression rates, but this seems extremely quick.

What should we expect?
Are there any treatments that can slow down the progression?
We need some hope and guidance during this challenging time.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

I am sorry to hear about your grandfather's challenges. Aggressive multiple sclerosis (MS) can be very daunting, especially with rapid progression like what you are describing. Here is some information and guidance:

Understanding aggressive MS

Rapid progression: Aggressive MS can lead to a swift decline in mobility and function compared to typical MS cases. It may resemble primary progressive MS (PPMS) or severe relapsing-remitting MS (RRMS) that transitions quickly to secondary progressive MS (SPMS).
Severity variations: Every case of MS is unique, and factors like lesion location, number, and immune response can influence progression

Treatment options

High-efficacy disease-modifying therapies (DMTs):

Alemtuzumab (Lemtrada) and Ocrelizumab (Ocrevus) are known for their potential to slow progression in aggressive cases.
Cladribine (Mavenclad) may also help with highly active MS.
If lesions are active (inflammatory), mitoxantrone or steroids may be considered.

Symptom management:

Physical therapy to preserve muscle strength and prevent complications from immobility.
Medications for spasticity (for example: Baclofen, Tizanidine) or fatigue (for example: Amantadine, Modafinil).

Clinical trials: Emerging treatments or interventions are often available through clinical trials for aggressive MS.

Prognosis and support:

While progression may seem overwhelming, DMTs and symptomatic treatments can often stabilize the condition or slow its advancement. Ensure regular follow-ups with an MS specialist to tailor treatment plans.

Consider consulting a neurologist specializing in aggressive MS if not already doing so.

Lifestyle adjustments

Diet: Anti-inflammatory diets (for example, Mediterranean diet ) can support overall health.
Rehabilitation: Occupational therapy and assistive devices can improve quality of life.
Emotional support: Counseling or MS support groups can help your family cope with stress.

I hope this has helped you. Please feel free to reach me again, in case of further queries.

Thank you.