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Review
. 2023 Jun 2:14:1207617.
doi: 10.3389/fneur.2023.1207617. eCollection 2023.

Aging in multiple sclerosis: from childhood to old age, etiopathogenesis, and unmet needs: a narrative review

Nicola Capasso  1   2 , Eleonora Virgilio  3 , Antonio Covelli  4 , Beatrice Giovannini  5 , Matteo Foschi  6   7 , Federico Montini  8 , Martina Nasello  9 , Annacarmen Nilo  10 , Elio Prestipino  11 , Giuseppe Schirò  12 , Silvia Sperandei  13 , Marinella Clerico  14 , Roberta Lanzillo  1   2
Affiliations
Review

Aging in multiple sclerosis: from childhood to old age, etiopathogenesis, and unmet needs: a narrative review

Nicola Capasso et al. Front Neurol. .

Abstract

Multiple sclerosis (MS) primarily affects adult females. However, in the last decades, rising incidence and prevalence have been observed for demographic extremes, such as pediatric-onset MS (POMS; occurring before 18 years of age) and late-onset MS (corresponding to an onset above 50 years). These categories show peculiar clinical-pathogenetic characteristics, aging processes and disease courses, therapeutic options, and unmet needs. Nonetheless, several open questions are still pending. POMS patients display an important contribution of multiple genetic and environmental factors such as EBV, while in LOMS, hormonal changes and pollution may represent disease triggers. In both categories, immunosenescence emerges as a pathogenic driver of the disease, particularly for LOMS. In both populations, patient and caregiver engagement are essential from the diagnosis communication to early treatment of disease-modifying therapy (DMTs), which in the elderly population appears more complex and less proven in terms of efficacy and safety. Digital technologies (e.g., exergames and e-training) have recently emerged with promising results, particularly in treating and following motor and cognitive deficits. However, this offer seems more feasible for POMS, being LOMS less familiar with digital technology. In this narrative review, we discuss how the aging process influences the pathogenesis, disease course, and therapeutic options of both POMS and LOMS. Finally, we evaluate the impact of new digital communication tools, which greatly interest the current and future management of POMS and LOMS patients.

Keywords: aging; engagement; immunosenescence; late-onset; multiple sclerosis; pediatric-onset; risk factors; unmet need.

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Conflict of interest statement

RL and MC received financial compensation for attendance to expert meetings as part of an educational programme by Merck Serono S.p.A., Rome, Italy, an affiliate of Merck. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Multiple Sclerosis (MS) incidence and effects of risk factors according to the age of onset. MS incidence gradually increases from childhood, peaking between the second and the fourth decade. Subsequently, a gradual decrease is seen with aging. Several risk factors have been associated mainly with POMS (MS onset <18 years), although their effect persists even in older ages (i.e., obesity, low blood vitamin D levels, viral infections, especially EBV). Other risk factors have been mainly associated with LOMS (MS onset >50 years), including air pollution, oxidative damage, chronic inflammation and hormonal changes. Although impacting on MS risk since childhood, the exposure to these factors may imply a longer time to increase the risk of developing MS. Lastly, genetic background influences MS risk throughout the lifetime.
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References

    1. Absinta M, Sati P, Masuzzo F, Nair G, Sethi V, Kolb H, et al. . Association of chronic active multiple sclerosis lesions with disability in vivo. JAMA Neurol. (2019) 76:1474–83. doi: 10.1001/jamaneurol.2019.2399, PMID: - DOI - PMC - PubMed
    1. Allen D, Gillen E, Rixson L. The effectiveness of integrated care pathways for adults and children in health care settings: a systematic review. JBI Libr Syst Rev. (2009) 7:80–129. doi: 10.11124/jbisrir-2009-182, PMID: - DOI - PubMed
    1. Alroughani R, Akhtar S, Ahmed S, Behbehani R, Al-Hashel J. Is time to reach EDSS 6.0 faster in patients with late-onset versus young-onset multiple sclerosis? PLoS One. (2016) 11:e0165846. doi: 10.1371/journal.pone.0165846, PMID: - DOI - PMC - PubMed
    1. Alroughani R, Boyko A. Pediatric multiple sclerosis: a review. BMC Neurol. (2018) 18:27. doi: 10.1186/s12883-018-1026-3, PMID: - DOI - PMC - PubMed
    1. Alroughani R, Huppke P, Mazurkiewicz-Beldzinska M, Blaschek A, Valis M, Aaen G, et al. . Delayed-release dimethyl fumarate safety and efficacy in pediatric patients with relapsing-remitting multiple sclerosis. Front Neurol. (2020) 11:606418. doi: 10.3389/fneur.2020.606418, PMID: - DOI - PMC - PubMed