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

## TL;DR

This study explores the challenges and care needs of patients with advanced multiple sclerosis, a group often overlooked in research and treatment.

## Contribution

The study provides a detailed characterization of advanced MS patients in institutional care, revealing significant gaps in treatment and evidence.

## Key findings

- Most patients had secondary progressive MS and limited exposure to disease-modifying therapies.
- Comorbidities and polypharmacy were common among patients.
- Half of the patients experienced EDSS progression during institutional care.

## Abstract

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.

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

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.

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.

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