Global experts, including several from Monash University, have developed guidelines to better manage multiple sclerosis (MS) in people aged over 50.
The consensus statement, published in Nature Reviews Neurology, was produced by an expert panel co-convened by the International Advisory Committee on Clinical Trials in MS (IACCT) and The European Committee for Treatment and Research in MS (ECTRIMS).
First author Associate Professor Anneke van der Walt, who leads the Monash University School of Translational Medicine MS and Neuro-ophthalmology Research Group and is Director, MS and Neuroimmunology Service at Alfred Health, said the statement highlighted an urgent need to transform the way MS was managed in people aged over 50.
“It brings together global experts to address what is fast becoming one of the most pressing challenges in MS care: ageing,” she said.
“Advancements in treatment and healthcare mean that people with MS are now living longer. More than half of the global MS population is aged 50 or older. Yet clinical trials, treatment guidelines, and diagnostic tools have not kept pace with this demographic shift.
“We are still managing MS in older adults using tools and approaches designed for younger people. This creates blind spots in diagnosis, under-treatment, and missed opportunities to improve quality of life.”
Co-author Professor Helmut Butzkueven, from Monash University’s School of Translational Medicine Department of Neuroscience, who is also Alfred Health’s Director of Neurology, said the guidelines were an important development.
“Ageing doesn’t just add complexity, it changes the disease itself. We need science and care models that reflect that reality,” Professor Butzkueven said.
The consensus identifies critical gaps and provides a roadmap for future care. Key recommendations include:
- better diagnostic frameworks to distinguish MS from common age-related conditions
- new tools to monitor disease activity and progression that account for biological ageing and comorbidities
- tailored treatment strategies, including guidance on when and how to safely de-escalate or discontinue therapy
- inclusion of older people in clinical trials, overcoming a long-standing barrier to evidence-based care
- integration of holistic, multidisciplinary care including exercise, mental health support, and management of cardiovascular risk factors.
The statement urges funders and regulators to prioritise research that includes older adults with MS, especially those with comorbidities who are typically excluded from clinical trials.
It also emphasises the voices of those living with MS, calling for better access to information, tailored education, and a stronger role in guiding their care decisions as they age.
Read the research paper, published in Nature Reviews Neurology: Diagnosis of multiple sclerosis: 2024 revisions of the McDonald criteria
DOI: https://doi.org/10.1038/s41582-025-01115-5
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