Study Findings Highlight Differences in MS Characteristics Between Sex, Disease Course

Recent study findings suggest that although clinical and demographic characteristics differ between men and women with multiple sclerosis (MS), these differences are more prevalent regarding the course of disease than when stratifying by sex. As a result, researchers are urging physicians to be aware of these differences and take appropriate measures, including optimization of pain therapy and neuropsychological care.

Publishing their findings of nearly 19,000 patients with relapsing onset MS (ROMS) or progressive onset MS (POMS), the researchers found that regardless of disease course, women were far more likely to be affected by pain (POMS and ROMS: P <.001), depression (POMS: P = .002, ROMS: .001), and cognitive impairment (POMS: P = .013; ROMS: P = .001). For depression, in particular, there was a higher prevalence in women when symptoms first emerged, and the difference continued to increase at the disease progressed.

“A new aspect of our analysis is that women with a relapsing onset leave work earlier and to a greater extent than men,” noted the researchers, adding, “This is surprising, since a more rapid disability progression and a faster progression of brain atrophy as well as a decrease in cognition has been described for male patients. However, in our study, we showed that neurophysiological symptoms are more prevalent in women than in men, even at an early disease stage.”

According to the researchers, these differences seen between the sexes were less pronounced than those seen between the courses of disease. For example, although optic neuritis and visual disturbances as initial symptoms were more common in woman than men for ROMS vs POMS (women: 44% vs 20%, respectively; men: 41% vs 18%), the differences were more pronounced between the disease courses.

Sensory deficits were also more common in patients with ROMS than in patients with POMS (women: 62% vs 46%, respectively; men: 59% vs 39%).

Meanwhile, motor symptoms (women: 71% vs 37%; men: 76% vs 41%) and cerebellar disorders (women: 34% vs 21%; men: 38% vs 23%) were more common in patients with POMS than in patients with ROMS, respectively. Similarly, gait problems, spasticity, and ataxia were the most common current symptoms in patients with POMS and were reported significantly more frequently in these patients compared with patients with ROMS.

According to the researchers, “Some of these differences, such as significantly more frequent gait problems, spasticity, ataxia, fatigue, pain, micronutrition problems, sexual dysfunction, and dysarthria in patients with POMS are probably due to the advanced stage of the disease.”

Although patients with POMS retired at a later age, they did so after a significantly shorter period of illness than patients with ROMS, and to a larger extent.

Reference

Rommer P, Ellenberger D, Hellwig K, et al. Relapsing and progressive MS: the sex-specific perspective. Ther Adv Neurol Disord. Published online September 23, 2020. doi:10.1177/1756286420956495