{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T06:25:34Z","timestamp":1787120734760,"version":"build-2736575974"},"reference-count":24,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>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\u2010onset MS (POMS), defined by symptom onset before age 18, accounts for 3%\u20135% of cases and may follow a prolonged but ultimately progressive trajectory. We report the case of an 83\u2010year\u2010old Iranian woman with an approximately 72\u2010year 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\u2010weighted sequences with associated cerebral atrophy, consistent with long\u2010standing demyelinating disease. Neuromyelitis optica spectrum disorder and MOG antibody\u2010associated disease were excluded. Immunosuppressive therapy with azathioprine was initiated at age 56 and continued for 5\u2009years. 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\u2010term physiotherapy and rehabilitation. Despite severe disability (Expanded Disability Status Scale 6.5) and lower\u2010limb paralysis, she has remained clinically stable under multidisciplinary follow\u2010up for nearly three decades. This case represents one of the longest documented MS disease durations and highlights the marked heterogeneity of long\u2010term 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.<\/jats:p>","DOI":"10.1002\/ccr3.73008","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T03:48:43Z","timestamp":1782186523000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Can Multiple Sclerosis be Managed Over a Lifetime? A Rare 72\u2010Year Journey of Pediatric\u2010Onset to Secondary Progressive Multiple Sclerosis"],"prefix":"10.1002","volume":"14","author":[{"given":"Masoud","family":"Etemadifar","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, School of Medicine Isfahan University of Medical Sciences  Isfahan Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0225-5209","authenticated-orcid":false,"given":"Ahmadreza","family":"Dehghani","sequence":"additional","affiliation":[{"name":"Student Research Committee Isfahan University of Medical Sciences  Isfahan Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahdi","family":"Rahimi","sequence":"additional","affiliation":[{"name":"Student Research Committee Isfahan University of Medical Sciences  Isfahan Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amirhossein","family":"Ghandehari","sequence":"additional","affiliation":[{"name":"Student Research Committee Isfahan University of Medical Sciences  Isfahan Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1675-681X","authenticated-orcid":false,"given":"Mehri","family":"Salari","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Shahid Beheshti University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.7861\/clinmedicine.16-6-s53"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2010.10.022"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/WCO.0000000000000094"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/09638288.2016.1211760"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-020-10279-7"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2009.158"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000003028"},{"issue":"24","key":"e_1_2_12_9_1","first-page":"e2764","article-title":"Long\u2010Term Disability Progression of Pediatric\u2010Onset Multiple Sclerosis","volume":"92","author":"KA M. 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