Life expectancy and multiple sclerosis: what you need to know

Life expectancy and multiple sclerosis: what you need to know

Multiple sclerosis is a long-term condition that affects the central nervous system with symptoms that can worsen over time. These symptoms can affect daily activities and reduce quality of life.

In the past, it had been estimated that multiple sclerosis (MS) shortens life expectancy by several years. According to one study published in Neurology, the life expectancy of people with MS is around 7-14 years lower than people without the condition.

Many factors affect life expectancy in people with MS. These include the patient's age when their MS begins, how severe the illness is, how quickly it progresses, and what treatment they receive.

Newer treatments for MS and better management of complications now offer the potential of life expectancy that is no different than for those without MS.

With "disease-modifying" therapies and rehabilitation, many people with MS can expect to live active lives with a lighter burden of symptoms than in the past.

Here are some key points about life expectancy and MS. More detail and supporting information is in the main article.

  • Relapse involves recurrence of symptoms persisting for at least 24 hours
  • Disease-modifying treatments can alter the long-term course of MS, including survival
  • The long-term course of MS also improves with management of conditions that occur alongside it
  • Activities of daily living and quality of life improve with rehabilitation

Modifying multiple sclerosis with new treatments

Research over the last two decades has produced treatments that target the autoimmune process of MS. This "disease-modifying" treatment is referred to as immunotherapy.

New drugs for MS could improve the long-term outlook for people with MS.

These drugs prevent the immune system from provoking the injury and inflammation in the nervous system.

Although immunotherapy products can be harmful to the body, they have been shown to reduce symptoms and offer the potential for long-term benefit.

Recent developments have broadened immunotherapy treatment options from injected drugs to two new products that can be taken by mouth.

In their review of this progress, Dr. Richard Ransohoff at the Cleveland Clinic in Cleveland, OH, and colleagues related that studies with the first immunotherapy products for MS "have shown that these agents reduce disease severity quite well for some patients, and might delay progression or lessen its impact."

In considering long-term outcomes and life expectancy, Dr. Ransohoff and colleagues reported:

A 21-year follow-up study of nearly every participant in the first clinical trial of (Interferon Beta-1b) showed a survival benefit for those receiving active drug during the trial, as compared with those given placebo."

Recognizing multiple sclerosis relapses

A relapse is when symptoms of a disease suddenly return after a period of improvement.

Treating relapses quickly could be important to the outlook for MS.

Although not all experts agree, some have found that delaying treatment of a relapse can worsen the long-term outcome of the illness. Avoiding delayed treatment can begin by looking out for the beginning of a relapse.

While symptoms can occur without warning, possible triggers for relapses include increased stress and an illness from infection.

Quick treatment of a relapse is more likely if symptoms are reported when they occur. The most common symptoms include:

  • Changes in vision, such as blurring or dimming
  • Changes in sensory feeling such as prickling or numbness
  • Changes in thought processes such as lack of attention and loss of focus on tasks
  • Changes in bladder control such as increased urgency to urinate

A doctor will need to decide whether or not the symptoms represent a relapse in MS before recommending treatment. The diagnosis of a relapse will be based on certain characteristics of the symptoms, such as if they remain for at least 24 hours without any fever or infection.

The diagnosis of relapse will also be made after ruling out other possible reasons for the symptoms.

The choice of a particular treatment and where to administer it will depend on the patient's MS history and severity, and previous responses to treatment.

In their report on relapse in MS published in the BMJ, Dr. Ian Galea of the University of Southampton, UK, and colleagues commented:

The decision to treat is best taken in conjunction with the patient in a process of shared decision making."

The researchers also discussed whether to start or step up a particular kind of treatment in view of potential risks. "Patients with multiple sclerosis are able to process evidence and scientific uncertainty without additional emotional burden..." they noted.

Initial treatment of relapse often involves a short course of high-dose drugs known as corticosteroids. These drugs counter the inflammation occurring in the affected areas of the central nervous system.

As corticosteroids may worsen an infectious illness, however, tests and treatment for infection may be undertaken before a course is started.

Dr. Galea and colleagues emphasize the importance of having appropriate expectations for the recovery from a relapse. They state that recovery occurs in the following way:

  • Significant recovery occurs within two or three months
  • Improvement may continue for up to 12 months
  • Some degree of disability remains after one-third to one-half of all relapses

Managing other conditions alongside multiple sclerosis

Other health conditions can occur alongside MS and further complicate its course. Preventing these conditions or effectively managing them, however, can avoid or limit their impact on quality of life and life expectancy with MS.

For example, some studies suggest that heart conditions such as ischemic heart disease and congestive heart failure may occur more often when MS is present than in the general population.

The possible reasons for a higher risk of conditions such as these can also be lifestyle factors. These lifestyle choices can be changed to reduce the risk.

In particular, individuals with MS:

  • Are more likely to be overweight
  • Have lower levels of physical activity
  • Have a higher risk of falling

Improving daily activities and quality of life

Rehabilitation can be used to change behaviors, as well as to improve everyday activities and quality of life.

In their overview of rehabilitation for MS, Dr. Serafin Beer of the Rehabilitation Center, Valens, Switzerland, and colleagues advise the following:

Training activities in MS patients should be individually adapted and generally started at a low to moderate intensity level with regular rest periods to minimize risk for deterioration."

Benefiting from exercise

Exercise can provide both short- and long-term benefits for people with MS.

In addition to possibly reducing risk of heart conditions, programs to increase physical activity in the presence of MS can have a range of short- and long-term benefits.

Benefits of exercise training in individuals with MS include reduced tiredness and anxiety, improved walking speed and muscle tone, and increases in friendship.

Targeted exercise programs have improved:

  • Walking ability, with the extra benefit of enabling more exercise
  • Balance, also reducing harm from falls

There may also be a direct benefit of exercise on the outlook of MS. In their review of exercise training in MS, researchers Robert Motl and Brian Sandroff describe a study finding a 27 percent lower rate of reported relapses in MS patients participating in exercise training than in the control group.

They note that some have speculated that exercise training might have its own "disease-modifying" effect in MS, but admit that there is yet little evidence for this.

"Regardless," Motl and Sandroff comment, "exercise training as a form of rehabilitation is of major importance in minimizing the influence of this disease on the lives of people with MS."

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Section Issues On Medicine: Disease