Managing Relapsing Multiple Sclerosis Across the Lifespan: A Narrative Review with Expert Opinion from Norway

Relapsing multiple sclerosis (RMS) is most often diagnosed in young adulthood but may also manifest during childhood or later in life. The number of older people living with RMS (pwMS) continues to grow as life expectancy increases and MS incidence rises among older adults. This review summarises the principal challenges in managing pwMS at different stages of life. Paediatric-onset RMS: RMS onset in childhood and adolescence is typically characterised by a higher relapse rate. Early diagnosis, timely intervention, and specialised care are essential. Management also requires close collaboration among healthcare providers, families, and educational institutions to help children balance the disease burden with academic, social, and family life. Young adults with RMS: In young adulthood, MS can disrupt education, employment, relationships, and family planning. Individualised treatment strategies and shared decision-making are essential to align disease management with evolving personal and professional goals. Older pwMS: Age-related issues such as immunosenescence, disability progression, comorbidities, polypharmacy, and menopause become increasingly relevant. Vaccination is particularly important given both immunomodulatory therapies and reduced immune resilience associated with immunosenescence. As pwMS age, treatment strategies may include disease-modifying therapy (DMT) de-escalation, discontinuation, or immune reconstitution therapies to reduce long-term immunosuppression. In conclusion, a holistic, pwMS-centred approach is essential to tailor MS management across the lifespan, adjusting to the medical, functional, and psychosocial needs of pwMS at each stage of life.