Late onset multiple sclerosis: concerns in aging patients

Lotti, Claudia Beatriz de Campos; Oliveira, Acary Souza Bullé; Bichuetti, Denis Bernardi; Castro, Isac de; Oliveira, Enedina Maria Lobato de

doi:10.1590/0004-282x20170070

Cited by 29 publications

(9 citation statements)

References 30 publications

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“…In our study, a high percentage of patients had OCBs in CSF, and this was observed across all age groups, consistent with other studies [9,10,24,30], which indicates that OCB is an effective diagnostic tool in patients of all ages. Patients with abnormal VEP also predominated in our study, in line with the work of Kis et al (AOMS: 70%; LOMS: 86%) [9] and Noseworthy et al (AOMS: 67%; LOMS: 62%) [43].…”

Section: Discussionsupporting

confidence: 92%

“…The presence of motor symptoms was found to be higher as age increased. Our findings are similar to those in studies comparing patients with AOMS and LOMS, where motor deficit was found to be the most common neurological manifestation among late-onset patients, encompassing more than half of the studied group (54.8-80%) [6,9,10,12,13,24,25]. Overrepresentation of motor deficit in older patients may be connected to the overrepresentation of the primary progressive form of the disease.…”

Section: Discussionsupporting

confidence: 89%

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Clinical and laboratory parameters by age for patients diagnosed with multiple sclerosis between 2000 and 2015

Małecka

Przybek-Skrzypecka

Kurowska

et al. 2021

Neurol Neurochir Pol.

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Aim of the study:To compare the demographic, clinical and laboratory characteristics of patients with multiple sclerosis (MS) analysed based on the age at which they were diagnosed.Clinical rationale for the study: Most cases of MS are diagnosed between the ages of 20 and 40 years, but the clinical characteristics of patients with MS over this age range have rarely been studied. Material and methods: 182 patients diagnosed with MS between 2000 and 2015 were divided into four groups by age at diagnosis: < 30 years (n = 62), 30-39 years (n = 54), 40-49 years (n = 27), and ≥ 50 years (n = 39). The demographic, clinical and laboratory features of each age group were investigated and between-groups comparisons analysed.Results: There were no significant differences in the female-to-male ratio between groups, which was close to 3:1 in every group (p = 0.98). Motor symptoms were more common as the first manifestation of MS with increasing age (< 30: 19.3%; 30-39: 37.0%; 40-49: 44.4%; ≥ 50: 61.5%). Visual and sensory symptoms were responsible for nearly half of first manifestations in patients < 30 to 49, but affected a significantly lower proportion of patients in the oldest group (p = 0.01). Median (interquartile range [IQR]) Expanded Disability Status Scale at diagnosis was higher with advancing age (2 [1.5-3], 2.25 [1.5-3.5], 3 [2-3.5], and 3.5 [3-5]; p < 0.01). There was also a higher proportion of patients with progressive forms of the disease with age, especially primary progressive MS (0.0%, 3.7%, 14.8%, and 51.3%; p < 0.01). The median (IQR) time needed to confirm the diagnosis of MS became significantly longer as age increased (7 [2-25], 9 [2-32], 12 [6-58], and 26 [12-60] months; p < 0.01). In laboratory tests, significant differences were found only in the rate of post-contrast enhancement by magnetic resonance imaging, which was lower in the older age groups (63.2%, 50.0%, 31.6%, and 30.0%; p < 0.01). Conclusions and clinical implications:Our study indicates significant differences in the demographic and clinical picture of MS depending on the age of the patient at diagnosis. Diagnostic delay in older patients is a common problem, and this study shows the features of later forms of MS to help inform neurologists and improve time to diagnosis.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 89%

Clinical and laboratory parameters by age for patients diagnosed with multiple sclerosis between 2000 and 2015

Małecka

Przybek-Skrzypecka

Kurowska

et al. 2021

Neurol Neurochir Pol.

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“…Some recent reports indicate an increasing numbers of patients with MS late onset, after 50 years of age [46,47]. We observed similar data in the 40-year follow-up of the prevalence in Ferrara, which demonstrates an increasing number of subjects with the late onset of the disease and a relatively increasing age at onset patients.…”

Section: Discussionsupporting

confidence: 88%

“…In Ferrara, the mean age had increased by about 4 years, 30.8 ± 9.6 years in 1978 and 34 ± 10.8 years in 2017. The late onset, associated mainly with a progressive course, seems to be predictor of reaching EDSS 3.0 and 6.0 in a short time [47].…”

Section: Discussionmentioning

confidence: 88%

Multiple Sclerosis in Italy: A 40-Year Follow-Up of the Prevalence in Ferrara

et al. 2018

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Background: To assess a longitudinal follow-up of the prevalence of multiple sclerosis (MS) through 4 decades in the province of Ferrara, northern Italy, and reappraise the current rates on December 31, 2016. Methods: We conducted a community-based intensive prevalence study, by adopting a complete enumeration approach. MS cases were identified from administrative health data and medical records from the Units of Neurology and Motor Rehabilitation, Ferrara University Hospital, from other provincial neurological structures and from archives of the National Pension Institute and National Health Insurance scheme of the study area. Case ascertainment method and case definition are analogous to those adopted in previous surveys in the same area of study. Results: On December 31, 2016, 685 patients (478 women and 207 men) affected by definite or probable MS (Poser’s criteria) were living in the province of Ferrara (population 386,896), yielding a crude prevalence ratio of 194.91 (95% CI 180.4–209.6) per 100,000, 260.8 (95% CI 238.10–285.82) for women and 123.1 (95% CI 106.98–141.21) for men The prevalence ratio was 26.9 per 100,000 in 1978, increased to a value of 46.1 per 100,000 in 1981, 69.4 per 100,000 in 1993, 120.9 per 100,000 in 2004. Female to male ratio was 2.31 (1.2 on December 31, 1978). The mean duration of the disease at prevalence day was 17.5 ± 11.9 years (13.9 ± 10.8 years in 1978). The mean age at prevalence day was 52.04 ± 10.8 years (13.8 ± 10.8 years in 1978). Conclusion: Our study has confirmed the province of Ferrara is an area at high risk for MS, in line with epidemiological data from the regions of continental and insular Italy. The sharp increase in MS prevalence over time in this population can be imputed in part to a greater exposition to risk factors in genetically susceptible subjects but also to an increased survival and improved ascertainment. So, the results suggest that both methodologic and environmental factors are essential in determining the real distribution of MS. The need to get reliable estimates of MS prevalence must be highlighted as a public health and research priority, essential to support planning and prioritization of care services and to reduce the overall burden of chronic disease.

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“…Following Krupp et al [18], participants were identified as having early onset MS (EOMS), if at disease onset their age was 18 years or under. Following Lotti et al [19], participants were identified as late onset of MS (LOMS), if at disease onset they were 50 years or older. Participants were identified as having adult onset MS (AOMS), if at disease onset they were between 18 and 49.9 years old.…”

Section: Samplementioning

confidence: 99%

Clinical Characteristics and Disability Progression of Early- and Late-Onset Multiple Sclerosis Compared to Adult-Onset Multiple Sclerosis

Mirmosayyeb

Brand

Barzegar

et al. 2020

JCM

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Background: Compared to the adult onset of multiple sclerosis (AOMS), both early-onset (EOMS) and late-onset (LOMS) are much less frequent, but are often under- or misdiagnosed. The aims of the present study were: 1. To compare demographic and clinical features of individuals with EOMS, AOMS and LOMS, and 2. To identify predictors for disability progression from relapsing remitting MS (RRMS) to secondary progressive MS (SPMS). Method: Data were taken from the Isfahan Hakim MS database. Cases were classified as EOMS (MS onset ≤ 18 years), LOMS (MS onset >50 years) and AOMS (MS >18 and ≤ 50 years). Patients’ demographic and clinical (initial symptoms; course of disease; disease patterns from MRI; disease progress) information were gathered and assessed. Kaplan–Meier and Cox proportional hazard regressions were conducted to determine differences between the three groups in the time lapse in conversion from relapsing remitting MS to secondary progressive MS. Results: A total of 2627 MS cases were assessed; of these 127 were EOMS, 84 LOMS and 2416 AOMS. The mean age of those with EOMS was 14.5 years; key symptoms were visual impairments, brain stem dysfunction, sensory disturbances and motor dysfunctions. On average, 24.6 years after disease onset, 14.2% with relapsing remitting MS (RRMS) were diagnosed with secondary progressive MS (SPMS). The key predictor variable was a higher Expanded Disability Status Scale (EDSS) score at disease onset. Compared to individuals with AOMS and LOMS, those with EOMS more often had one or two relapses in the first two years, and more often gadolinium-enhancing brain lesions. For individuals with AOMS, mean age was 29.4 years; key symptoms were sensory disturbances, motor dysfunctions and visual impairments. On average, 20.5 years after disease onset, 15.6% with RRMS progressed to SPMS. The key predictors at disease onset were: a higher EDSS score, younger age, a shorter inter-attack interval and spinal lesions. Compared to individuals with EOMS and LOMS, individuals with AOMS more often had either no or three and more relapses in the first two years. For individuals with LOMS, mean age was 53.8 years; key symptoms were motor dysfunctions, sensory disturbances and visual impairments. On average, 14 years after disease onset, 25.3% with RRMS switched to an SPMS. The key predictors at disease onset were: occurrence of spinal lesions and spinal gadolinium-enhancement. Compared to individuals with EOMS and AOMS, individuals with LOMS more often had no relapses in the first two years, and higher EDSS scores at disease onset and at follow-up. Conclusion: Among a large sample of MS sufferers, cases with early onset and late onset are observable. Individuals with early, adult and late onset MS each display distinct features which should be taken in consideration in their treatment.

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Late onset multiple sclerosis: concerns in aging patients

Cited by 29 publications

References 30 publications

Clinical and laboratory parameters by age for patients diagnosed with multiple sclerosis between 2000 and 2015

Clinical and laboratory parameters by age for patients diagnosed with multiple sclerosis between 2000 and 2015

Multiple Sclerosis in Italy: A 40-Year Follow-Up of the Prevalence in Ferrara

Clinical Characteristics and Disability Progression of Early- and Late-Onset Multiple Sclerosis Compared to Adult-Onset Multiple Sclerosis

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