Challenges and Considerations in the Care Management of Advanced Stages of Multiple Sclerosis: Sam Hooshmand, DO

WATCH TIME: 3 minutes

"Advanced MS is a particularly challenging entity, and we as neurologists need to advocate and work with our industry partners to try to include these patients in clinical trials to get the data we need to make better decisions in terms of disease-modifying therapies."

Advanced multiple sclerosis (MS), particularly secondary progressive MS (SPMS), is often characterized by insidious neurologic decline marked by increasing physical disability, cognitive dysfunction, and a significant symptom burden. Traditional tools like the Expanded Disability Status Scale (EDSS), commonly used by clinicians to assess disease progression, may underrepresent cognitive, bowel/bladder, and sensory deficits in later stages of the disease, symptoms that can precede overt motor deterioration.¹ Therefore, early identification of these changes, aided by cognitive screening tools and digital assessments, may support more proactive care strategies before functional decline becomes pronounced in patients.

Besides the complexity of diagnosis, the management of advanced MS in clinical practice presents distinct challenges, largely because of the lack of definitive evidence from pivotal clinical trials, which have typically excluded patients with EDSS scores above 6.5. In a recent meta-analysis, findings suggested that disease-modifying therapies could offer some benefit in slowing progression in patients with progressive MS, though their use should possibly be carefully balanced against adverse risks.² As a result, there is a growing clinical imperative to include more patients with advanced MS in trials and to tailor treatment approaches based on disease progression as well as individual risk-benefit considerations.

At the recently concluded 2025 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, held May 28-31, 2025, in Phoenix, Arizona, Sam Hooshmand, DO, an assistant professor of neurology at the Medical College of Wisconsin, spoke with NeurologyLive^® on the lack of a universally accepted definition of advanced MS.³ Using aspects from his talk presented at the meeting, Hooshmand emphasized the limitations of using the EDSS score alone to assess disease progression and the significant impact of secondary complications on advanced MS. Furthermore, he highlighted the importance of personalized care that supports functional independence and noted the absence of patients with advanced MS in most disease-modifying therapy clinical trials.

Click here for more coverage of CMSC 2025.

REFERENCES
1. Pozzilli C, Pugliatti M, Vermersch P, et al. Diagnosis and treatment of progressive multiple sclerosis: A position paper. Eur J Neurol. 2023;30(1):9-21. doi:10.1111/ene.15593
2. Wu X, Wang S, Xue T, et al. Disease-modifying therapy in progressive multiple sclerosis: a systematic review and network meta-analysis of randomized controlled trials. Front Neurol. 2024;15:1295770. Published 2024 Mar 11. doi:10.3389/fneur.2024.1295770
2. Hooshmand S. Advanced Disease States in Multiple Sclerosis: A Clinical Perspective. Presented at: 2025 CMSC Annual Meeting; May 28-31; Phoenix, AZ. Whitaker Track Invited Lectures: MS in Special Populations.