Brain MRI in late‐onset multiple sclerosis

Abstract

Multiple sclerosis (MS) with clinical onset after 50 years of age is unusual (between 1 and 6%) and is frequently misdiagnosed. Furthermore, brain magnetic resonance imaging (MRI) abnormalities are frequently observed in subjects over 50 years of age. The aim of this study was to describe brain MRI in late-onset MS to evaluate the sensitivity and specificity of radiological MS criteria in patients aged over 50 years. We evaluated the brain MRI of 20 patients with onset of MS after 50 years of age. We compared these MRI with 26 controls matched for age, sex and vascular risk factors. MRI were blindly analysed by two neuroradiologists according to Paty et al.'s [Neurology38 (1988) 180] criteria, Fazekas et al.'s [Neurology38 (1988) 1822] criteria and Barkhof et al.'s [Brain120 (1997) 2059] criteria. The mean age at MRI scanning was 58 years. Sensitivity was 90% for Paty et al.'s criteria, 80% for Fazekas et al.'s criteria and 85% for Barkhof et al.'s criteria. Specificity was 54% for Paty et al.'s criteria, 69% for Fazekas et al.'s criteria and 65% for Barkhof et al.'s criteria. Barkhof et al.'s criteria are less specific in older patients than in young patients. We suggest that spinal cord MRI and cerebrospinal fluid analysis should be systematically performed in suspected late-onset MS in order to increase the specificity of the diagnosis.

Late onset multiple sclerosis: concerns in aging patients

“…We observed that 50% of the 12 LOMS patients submitted to spinal MRI had lesions, thus helping to differentiate between MS and vascular diseases 11,14,18 . Our study demonstrated that spinal MRI may be a helpful diagnostic tool only in the primary progressive LOMS group, in which we found 75% of clusters with lesions shown in spinal MRI, a high percentage, as expected in this clinical course 6,11,18 . Clearly, there are limitations to our study.…”

“…Therefore, an uncommon form of MS is one in which symptoms start at 50 plus years of age, called late onset multiple sclerosis (LOMS) 1,2,3,4,5,6,7,8 . It accounts for 1.4% to 9.9% of the MS population in different countries 2,4,5,7,9,10,11,12 .…”

Late‐onset and young‐onset relapsing‐remitting multiple sclerosis: evidence from a retrospective long‐term follow‐up study

“…Symptoms of LOMS, such as fatigue or walking disturbance, can also be mistaken for signs of normal aging. Moreover, on MRI scan of the brain, physicians may attribute the white matter damage to blood vessel disease .…”

Diagnosis of multiple sclerosis: progress and challenges

“…Establishing a diagnosis of MS can be more difficult in older adults because white matter lesions due to small-vessel cerebrovascular disease are frequently found on brain MRI. 7,37 In this situation a stringent interpretation of brain MRI criteria for MS is mandatory and spinal cord MRI is helpful since spinal cord lesions do not occur with healthy aging. 11…”