Clinical characteristics of patients with late-onset multiple sclerosis

Abstract

We evaluated clinical presentation, cerebrospinal fluid (CSF), and magnetic resonance imaging (MRI) in patients with late-onset multiple sclerosis (LOMS). Fifty-two patients with definitive multiple sclerosis (MS) diagnosed after the age of 50 years were identified between 1991 and 2002. Data pertaining to clinical characteristics, CSF analysis, and cerebral and spinal MRI were compared with those of 52 young-onset MS (YOMS) patients matched for sex and disease duration. Mean age at the time of diagnosis was 57 years in the LOMS group - the oldest patient was 82 - and 29 years in the YOMS group. Motor symptoms were significantly more often present in the LOMS than in patients with YOMS (90 % vs. 67 %, p = 0.014). Visual symptoms, residual signs of optic neuritis, and dysarthria were less frequent for LOMS. Sensory symptoms, ataxia, oculomotor symptoms, cognitive disorder, or fatigue did not differ between both groups. The majority of LOMS patients (83 %) had a primary progressive disease course, whereas 94 % of the YOMS group had a relapsing-remitting course. MRI showed typical multifocal supratentorial (LOMS vs. YOMS: 96 % vs. 98 %) and infratentorial (44 % vs. 62 %) lesions without significant group differences. Of particular interest, spinal lesions were more common (81 %) in LOMS compared to YOMS (48 %, p = 0.024), and cerebellar lesions were less frequent in the LOMS group (11 % vs. 44 %, p = 0.001). Gadolinium-enhanced lesions were initially present in less LOMS patients (15 %) than in YOMS (63 %, p < 0.001). CSF analysis revealed pleocytosis less frequently in LOMS (34 %) compared to YOMS (67 %, p = 0.006) but oligoclonal banding occurred without in both groups without differences. YOMS patients responded to corticosteroids (93 %) to a significantly greater degree than LOMS patients (73 %; p = 0.004). For individuals who develop LOMS, a primary progressive course is frequent, with motor symptoms as the prominent feature. Vigilance is necessary to recognise MS in this population because of its unusual presentation.

Association analysis of cytokine receptors’ genes polymorphisms with clinical features of multiple sclerosis

“…Поэтому ценность представ-ляют ранние клинические признаки, которые в той или иной степени могут прогнозировать течение РС для данного пациента. В ряде исследований показа-но, что варианты манифестации (ВМ) РС ассоции-рованы с дальнейшим течением заболевания [2,18]. К прогностически благоприятным ВМ отнесены оптический неврит и нарушения чувствительности; к неблагоприятным -нарушения функций ствола мозга, координации, нарушения двигательных, та-зовых или психических функций, а также полисим-птомная манифестация РС.…”

Late onset multiple sclerosis: concerns in aging patients

“…Vascular disease of the central nervous system and cervical spondylotic myelopathy are the main differential diagnoses, due to a higher prevalence at this age and possible similar symptoms 1,4,13,17,18 . Because of previous co-morbid conditions and higher odds of T2-hyperintense lesions on magnetic resonance imaging (MRI) of elderly patients 7,13,19 , there is a delay in diagnosis that can reach three to five years in almost 40% of LOMS patients 7,14,20 . There is scanty literature concerning what influences the presentation and progression to disability in this age group, and few papers compare this population with young MS adults.…”

“…It accounts for 1.4% to 9.9% of the MS population in different countries 2,4,5,7,9,10,11,12 . On average, LOMS represents roughly 4.5% of the MS population 2,4,5,7 , it has a female preponderance 1,2,4,7,12 , its initial presentation is monosymptomatic, with a motor or cerebellar symptom, and the most common clinical course is primary progressive 4,13,14 . The progression to disability in LOMS has previously been attributed to disease duration time 15 , to clinical form 2 , gender 8 , and older age at the time of the patient's first examination 13 .…”

Primary central nervous system vasculitis: clinical experiences with 21 new European cases

“…Due to our clinical experience the spectrum of differential diagnoses in patients admitted to us for second opinion in evaluation of PCNSV consists of noninflammatory vasculopathy due to arteriosclerosis [18] or drugs [33], Moyamoya disease and syndrome [24] and Sneddon´s syndrome [20][21][22]25] as well as atypical cases of multiple sclerosis [19]. One other important differential diagnosis of PCNSV is bacterial endocarditis [4], because both conditions may present with similar clinical and auxiliary findings but effort a different treatment regimen [5].…”