Management of multiple sclerosis (MS) has shifted from supportive to disease modifying therapy. Considering the increasingly widespread adoption of this approach in managing MS patients, we hypothesized that hospitalizations and surrogates of disease-related complications should have declined during the last decade. Methods. Using the Nationwide Inpatient Sample, hospitalizations for MS and associated secondary diagnoses and procedures as well as discharge status were examined. Time trends were examined for different age cohorts focusing on the period from 2001 to 2010. Results. During the preceding decade, annual hospitalizations for MS increased by 40%, with stable rates in all age groups except geriatric patients, who accounted for a significantly higher fraction of admissions. Nursing home transfers as a surrogate marker of disability remained unchanged for all age groups. Similarly, urinary tract infections, the need for skin debridement, or gastrostomy tube placement did not vary during the decade. Conclusion. During a time of increased adoption of disease modifying therapy, MS-related hospitalizations continued to increase and surrogate measures of disability in admitted patients remained stable, demonstrating the still significant impact of the disease on affected individuals. 1. Introduction Multiple sclerosis (MS) tends to have a progressive course with gradual loss of function in many affected individuals. Within about 10 years, 25–30% of the affected individuals will require a cane or wheelchair to compensate restricted mobility [1–3]. With loss of lower extremity strength, many patients also develop anorectal, urinary, and sexual dysfunction [4–6]. We have recently reviewed the prevalence of anorectal dysfunction in MS [7]. While different recruitment strategies and definitions of key endpoints complicate the comparison of published results, constipation and fecal incontinence are commonly reported with rates being relatively stable over time. These results appear to be consistent with studies on the prevalence of urinary symptoms and problems due to neurogenic bladder. Urgency or urinary incontinence remain common affecting 10–50% of the patients and increasing their risk of urinary tract infection and hospitalization [5, 6, 8–10]. The consistently high likelihood of experiencing problems due to neurogenic bladder or bowel dysfunction stands in apparent contrast with the presumed benefits of disease modifying therapy (DMT) that has been introduced about one decade ago. Initial studies of glatiramer acetate described a 30% reduction of
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