Article Text

Download PDFPDF
Short report
Shift of multiple sclerosis onset towards older age
  1. Luca Prosperini1,
  2. Matteo Lucchini2,3,
  3. Serena Ruggieri4,5,
  4. Carla Tortorella1,
  5. Shalom Haggiag1,
  6. Massimiliano Mirabella2,3,
  7. Carlo Pozzilli4,
  8. Claudio Gasperini1
  1. 1Dept. of Neurosciences, S. Camillo-Forlanini Hospital, Roma, Italy
  2. 2Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Neurologia, Roma, Italy
  3. 3Università Cattolica del Sacro Cuore, di Neuroscienze, Centro di Ricerca per la Sclerosi Multipla (CERSM), Roma, Italy
  4. 4Dept. of Human Neurosciences, Sapienza University, Roma, Italy
  5. 5Neuroimmunology Unit, S. Lucia Foundation, Roma, Italy
  1. Correspondence to Dr Luca Prosperini, Dept. of Neurosciences, S. Camillo-Forlanini Hospital, Roma, Italy; luca.prosperini{at}


Objective To explore whether age at onset increased over time despite a shortened interval from the initial clinical demyelinating event to the diagnosis of multiple sclerosis (MS), as promoted by updated diagnostic criteria.

Methods This was an independent, multicentre, retrospective study based on data from 4345 patients with relapsing-onset MS attending three tertiary MS Clinics in Italy. After stratifying the year of MS onset into four periods (<1991, 1991–2000, 2001–2010, 2011–2021), we analysed the temporal trends in age at onset and interval from onset to diagnosis; we then explored the female-to-male ratio and onset location across different classes of age at onset.

Results We observed an increased mean age at onset, and a shortened mean interval to diagnosis over time (p<0.0001). Accordingly, there were more MS onsets at the older age classes of 40-49, 50–59 and ≥60 years (p<0.0001). In cases with age at onset ≥40 years, we also found an increased female-to-male ratio (p=0.007), more frequent spinal cord (p=0.0004) and less frequent supratentorial onset (p=0.008).

Conclusion Our study shows a forward shift towards an older age at onset of MS, thus suggesting considerable thought on the place-in-therapy of most currently used disease-modifying treatments, and on the standard of care to an older population.


Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors Conception and design of the study, drafting a significant portion of the manuscript/figures: LP, ML, SR and SH. Acquisition and analysis of data, revision of manuscript content: LP, ML, SR, SH, CT, MM, CP and CG. Supervision and drafting the final version of the manuscript: CT, MM, CP and CG.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.