Can Multiple Sclerosis be Managed Over a Lifetime? A Rare 72‐Year Journey of Pediatric‐Onset to Secondary Progressive Multiple Sclerosis

ABSTRACT

Multiple sclerosis (MS) is a chronic demyelinating disorder of the central nervous system characterized by cumulative neurological disability over time. Median survival from symptom onset in large cohort studies is approximately four decades, although substantially prolonged disease courses are uncommon. Pediatric‐onset MS (POMS), defined by symptom onset before age 18, accounts for 3%–5% of cases and may follow a prolonged but ultimately progressive trajectory. We report the case of an 83‐year‐old Iranian woman with an approximately 72‐year history of MS, representing an exceptionally prolonged disease course. Her initial symptom, bilateral optic neuritis, occurred at age 11. She experienced recurrent relapses, including paraplegia and multifocal neurological deficits, before establishing care at our facility at age 55. At that time, diagnostic evaluation included brain magnetic resonance imaging (MRI), visual evoked potentials, cerebrospinal fluid analysis, and laboratory investigations to exclude infectious and autoimmune etiologies. MRI demonstrated periventricular and callosal hyperintense lesions on T2‐weighted sequences with associated cerebral atrophy, consistent with long‐standing demyelinating disease. Neuromyelitis optica spectrum disorder and MOG antibody‐associated disease were excluded. Immunosuppressive therapy with azathioprine was initiated at age 56 and continued for 5 years. By age 58, her disease course evolved into secondary progressive MS (SPMS). Following this transition, management focused on symptomatic treatment, including baclofen for spasticity and long‐term physiotherapy and rehabilitation. Despite severe disability (Expanded Disability Status Scale 6.5) and lower‐limb paralysis, she has remained clinically stable under multidisciplinary follow‐up for nearly three decades. This case represents one of the longest documented MS disease durations and highlights the marked heterogeneity of long‐term outcomes in POMS transitioning to SPMS. Sustained multidisciplinary care, appropriate immunosuppressive therapy, and structured supportive management may contribute to extended survival and preserved quality of life even in advanced disease.