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Late onset multiple sclerosis: Is it really late onset?

      Highlights

      • Prior neurological symptoms of demyelination are common in patients with LOMS.
      • RRMS is more common than we had expected.
      • SPMS is the most common progressive clinical course.
      • Males are relatively more common compared to younger MS patients.

      Abstract

      Background

      Multiple sclerosis (MS) is the most common demyelinating disease, and onset over the age of 50 years is referred to as late onset MS (LOMS). It has been thought that LOMS patients will be more likely to exhibit a primary progressive (PPMS) clinical course.

      Objective

      To identify the clinical characteristics of demyelinating disease in patients over the age of 50 years from four different MS centers in the Northern Midwest USA.

      Methods

      We reviewed medical records of all patients seen at the MS centers and identified those who were 50 years of age or more at the time of first spontaneously reported symptoms. We included those who were diagnosed with MS or clinically isolated syndrome (CIS) and excluded MS mimickers. Demographics, initial clinical course diagnosis, clinical characteristics, and any available five-year follow up data were collected. The clinical course was reevaluated in each patient with careful questioning regarding any prior focal neurological symptoms that had persisted for at least 48 h, not otherwise explained. Those with a prior event who were initially diagnosed with PPMS or CIS were reclassified as secondary-progressive MS (SPMS) and relapsing-remitting MS (RRMS) respectively.

      Results

      We identified 124 patients from a total of 3700 patients, making LOMS 3.4% MS in our population. The initial clinical course was RRMS in 50 (40%), PPMS in 44 (36%), SPMS in 15 (12%), and CIS in 15 (12%) patients. After reclassification the clinical course was RRMS in 55 (44%), PPMS in 25 (20%), SPMS in 34 (28%), and CIS in 10 (8%) patients. The clinical syndrome was identified as acute for 77 patients (62%) with transverse myelitis (N=25, 32%) as the most common type. The clinical syndrome was chronic for 47 patients (37%) and again transverse myelitis (N=24, 51%) was the most common type. Five-year follow up data was available for 44% of these patients.

      Discussion

      LOMS is rare and RRMS is the most common clinical course. Reclassification of the clinical course, not done before in any other LOMS study, with careful questioning regarding a prior neurological event reveals that SPMS is the most common type of progressive MS and PPMS may be less common than previously thought. Transverse myelitis is the most common clinical presentation.

      Keywords

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      References

        • Azzimondi G.
        • Stracciari A.
        • Rinaldi R.
        • D’Alessandro R.
        • Pazzaglia P.
        Multiple sclerosis with very late onset: report of six cases and review of the literature.
        Eur Neurol. 1994; 34: 332-336
        • Bauer H.J.
        • Hanefled F.A.
        Multiple sclerosis: its impact from childhood to old age.
        W.B. Saunders, London1993
        • Bove R.
        • Healy B.
        • Augustine A.
        • Musallam A.
        • Gholipour T.
        • Chitnis T.
        Effect of gender on later onset multiple sclerosis.
        Mult Scler. 2012; 18: 1472-1479
        • Cazzullo C.L.
        • Ghezzi A.
        • Marforio S.
        • Caputo D.
        Clinical picture of multiple sclerosis with late onset.
        Acta Neurol Scand. 1978; 58: 190-196
        • Compston A.
        • Cole A.J.
        Multiple sclerosis.
        Lancet. 2002; 359: 1221-1231
        • Confavreux C.
        • Aimard G.
        • Devic M.
        Course and prognosis of multiple sclerosis assessed by the computerized data processing of 349 patients.
        Brain. 1980; 103: 281-300
        • Crossburn M.
        • Ingram G.
        • Hirst C.
        • Ben-Shlomo Y.
        • Pickersgill T.P.
        • Robertson N.P.
        Age at onset as a determinant of presenting phenotype and initial relapse and recovery in multiple sclerosis.
        Mult Scler. 2012; 18: 45-54
        • Hooge J.P.
        • Redekop W.K.
        Multiple sclerosis with very late onset.
        J Neurol. 1992; 42: 1907-1910
        • Kis B.
        • Rumberg B.
        • Berlit P.
        Clinical characteristics of patients with late-onset multiple sclerosis.
        J Neurol. 2008; 255: 697-702
        • Liguori M.
        • Marrosu M.G.
        • Pugliatti M.
        • Giuliani F.
        • De Robertis F.
        • Cocco E.
        • et al.
        Age at onset in multiple sclerosis.
        Neurol Sci. 2000; 21: 825-829
        • Lublin F.
        • Reingold S.
        Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis.
        Neurology. 1996; 46: 907-911
        • Martinelli V.
        • Rodegher M.
        • Moiola L.
        • Comi G.
        Late onset multiple sclerosis: clinical characteristics, prognostic factors and differential diagnosis.
        Neurol Sci. 2004; 25: 350-355
        • McDonald W.I.
        • Compston A.
        • Edan G.
        • Hartung H.P.
        • Lumlin F.D.
        • McFarland H.F.
        • et al.
        Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis.
        Ann Neurol. 2001; 50: 121-127
        • Miller D.H.
        • Weinshenker B.G.
        • Filippi M.
        • Banwell B.L.
        • Cohen J.A.
        • Freedman M.S.
        • et al.
        Differential diagnosis of suspected multiple sclerosis: a consensus approach.
        Mult Scler. 2008; 14: 1157-1174
        • Moreau T.
        • Confavreux C.
        Can the prognosis of multiple sclerosis be predicted?.
        Pathol Biol. 2000; 48: 132-138
        • Paolino E.
        • Fainardi E.
        • Ruppi P.
        • Tola M.R.
        • Govoni V.
        • Casetta I.
        • et al.
        A prospective study on the predictive value of CSF oligoclonal bands and MRI in acute isolated neurological syndromes for subsequent progression to multiple sclerosis.
        J Neurol Neurosurg Psychiatry. 1996; 60: 572-575
        • Phadke J.G.
        Clinical aspects of multiple sclerosis in north-east Scotland with particular reference to its course and prognosis.
        Brain. 1990; 113: 1597-1628
        • Polliack M.
        • Barak Y.
        • Achiron A.
        Late-onset multiple sclerosis.
        J Am Geriatr Soc. 2001; 49: 168-171
        • Poser C.M.
        • Paty D.W.
        • Scheinberg L.
        • McDonald W.I.
        • Davis F.A.
        • Ebers G.C.
        • et al.
        New diagnostic criteria for multiple sclerosis: guidelines for research protocols.
        Ann Neurol. 1983; 13: 227-231
        • Pugliatti M.
        • Rosati G.
        • Carton H.
        • Riise T.
        • Drulovic J.
        • Vecsei L.
        • et al.
        The epidemiology of multiple sclerosis in Europe.
        Eur J Neurol. 2006; 13: 700-722
        • Qiu W.
        • Wu J.S.
        • Castley A.
        • James I.
        • Joseph J.
        • Christiansen F.T.
        • et al.
        Clinical profile and HLA-DRB1 genotype of late onset multiple sclerosis in Western Australia.
        J Clin Neurosci. 2010; 17: 1009-1013
        • Rosati G.
        The prevalence of multiple sclerosis in the world: an update.
        Neurol Sci. 2001; 22: 117-139
        • Runmarker B.
        • Andersson C.
        • Oden A.
        • Andersen O.
        Prediction of outcome in multiple sclerosis based on multivariate models.
        J Neurol. 1994; 241: 597-604
        • Sellner J.
        • Luthi N.
        • Buhler R.
        • Gebhardt A.
        • Findiling O.
        • Greeve I.
        • et al.
        Acute partial transverse myelitis: risk factors for conversion to multiple sclerosis.
        Eur J Neurol. 2008; 15: 398-405
        • Shams P.N.
        • Plant G.T.
        Optic neuritis: a review.
        Int MS J. 2009; 16: 82-89
        • Steinman L.
        Autoimmune disease.
        Sci Am. 1993; 269: 106-114
        • Thompson A.J.
        • Polman C.H.
        • Miller D.H.
        • McDonald W.I.
        • Brochet B.
        • Filippi M.
        • et al.
        Primary progressive multiple sclerosis.
        Brain. 1997; 120: 1085-1096
        • Tremlett H.
        • Devonshire V.
        Is later onset multiple sclerosis associated with a worse outcome?.
        J Neurol. 2006; 67: 954-959
        • Weinshenker B.G.
        • Bass B.
        • Rice G.P.A.
        • Noseworthy J.
        • Carriere W.
        • Baskerville J.
        • et al.
        The natural history of multiple sclerosis: a geographical based study. 1. Clinical course and disability.
        Brain. 1989; 112: 133-146
        • Weinshenker B.G.
        Progressive forms of MS: classification streamlined or consensus overturned?.
        Lancet. 2000; 355: 162-163
        • White A.D.
        • Swingler R.J.
        • Compston D.A.
        Features of multiple sclerosis in older patients in South Wales.
        Gerontology. 1990; 36: 159-164