Esclerosis múltiple de comienzo tardío

Arias, Manuel; Dapena, D; Arias-Rivas, Susana; Costa, E.; López, A.; Prieto, José M.; Corredera, E

doi:10.1016/j.nrl.2010.09.008

Cited by 20 publications

(12 citation statements)

References 19 publications

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“…2–6 However, a monophasic clinical course was more common than recurrent relapses in the older cohort, with 60% of patients experiencing only one episode. This may represent the high mortality rate or limited follow-up.…”

Section: Discussionmentioning

confidence: 97%

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Clinical–radiological–pathological spectrum of central nervous system–idiopathic inflammatory demyelinating disease in the elderly

et al. 2016

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Background The spectrum of CNS idiopathic inflammatory demyelinating disease (CNS-IIDD) in the elderly is uncertain. Objective To describe the clinical, radiological, and pathological features of a cohort of 30 pathologically proven CNS-IIDD patients ≥65 years. Methods Elderly MS/CIS patients were compared to a cohort of 125 patients with pathologically proven MS/CIS and symptom onset <65 years. Results Median age at symptom onset was 69 years (IQR 68–75). Median follow-up was 1.9 years (IQR 1.0–5.6). Diagnoses were MS (14/30), CIS (11/30), NMO (4/30), and ADEM (1/30). Disability was higher in patients with MS/CIS ≥65 compared to patients <65 (median EDSS 4 [IQR 2.5–7] vs. 2.5 [IQR 1.5–4]; p=0.002). When compared to patients <65, there was no difference in the lesion size, number of patients fulfilling Barkhof’s criteria, edema or mass effect. Confluent demyelination was observed in 27 patients [MS/CIS (23/25), NMO (4)], two had a mixed perivenular/confluent pattern [MS (1), ADEM(1)] and one patient with MS had a mixed confluent/perivenular/coalescent pattern. Early active lesions were found in 19/30 patients ([MS 4, CIS 13, NMO 2], 53%). Cortical demyelination was present in 7/12 (58%) patients [MS(3), CIS(3), ADEM (1)]. Conclusions A spectrum of CNS-IIDD can develop in the elderly, with presenting symptoms similar to younger patients. Early diagnosis of CNS demyelinating disease is essential to avoid invasive and disabling procedures.

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Section: Discussionmentioning

confidence: 97%

“…11, 12 The prognosis in patients with late onset MS is uncertain, with some studies demonstrating a worse prognosis when compared to younger patients 2, 6, 7 and some reporting no difference. 10 There is no large series of patients with pathologically proven CNS-IIDD of onset after the age of 65.…”

Section: Introductionmentioning

confidence: 99%

Clinical–radiological–pathological spectrum of central nervous system–idiopathic inflammatory demyelinating disease in the elderly

et al. 2016

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“…[4] Although the two entities can coexist in select (rare) patients, more typically MS predominates. In Arias et al .…”

Section: Neurological Diseasesmentioning

confidence: 99%

“…series, 18 MS patients presented at the average age of 50 years (12 females and 6 males), and their most frequent initial symptoms included; motor deficits (33%), multisystem deficits (33%), and cerebellar disorders (16%). [4] The clinical course (minimum 5-year follow-up) included: primary progressive-MS (62%), secondary progressive-MS (22%), or relapsing-remitting-MS (16%).…”

Section: Neurological Diseasesmentioning

confidence: 99%

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How much medicine do spine surgeons need to know to better select and care for patients?

Epstein

2012

Surg Neurol Int

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Background:Although we routinely utilize medical consultants for preoperative clearance and postoperative patient follow-up, we as spine surgeons need to know more medicine to better select and care for our patients.Methods:This study provides additional medical knowledge to facilitate surgeons’ “cross-talk” with medical colleagues who are concerned about how multiple comorbid risk factors affect their preoperative clearance, and impact patients’ postoperative outcomes.Results:Within 6 months of an acute myocardial infarction (MI), patients undergoing urological surgery encountered a 40% mortality rate: similar rates may likely apply to patients undergoing spinal surgery. Within 6 weeks to 2 months of placing uncoated cardiac, carotid, or other stents, endothelialization is typically complete; as anti-platelet therapy may often be discontinued, spinal surgery can then be more safely performed. Coated stents, however, usually require 6 months to 1 year for endothelialization to occur; thus spinal surgery is often delayed as anti-platelet therapy must typically be continued to avoid thrombotic complications (e.g., stroke/MI). Diabetes and morbid obesity both increase the risk of postoperative infection, and poor wound healing, while the latter increases the risk of phlebitis/pulmonary embolism. Both hypercoagluation and hypocoagulation syndromes may require special preoperative testing/medications and/or transfusions of specific hematological factors. Pulmonary disease, neurological disorders, and major psychiatric pathology may also require further evaluations/therapy, and may even preclude successful surgical intervention.Conclusions:Although we as spinal surgeons utilize medical consultants for preoperative clearance and postoperative care, we need to know more medicine to better select and care for our patients.

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