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Age Should Not Deter Multiple Sclerosis Diagnosis: Presented at ECTRIMS
By Bruce Sylvester

MADRID, SPAIN -- October 1, 2006 -- In a new study of patients diagnosed with multiple sclerosis (MS) after the age of 60, nearly half of relapsing patients with relapsing-remitting multiple sclerosis (RRMS) and patients with clinically isolated syndrome presented with signs of inflammation on magnetic resonance imaging (MRI).

This finding suggests that the disease course depends on the inflammatory component of MS and not just age, said researchers who presented the findings here on September 29th at the 22nd Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS).

"We have found that persons over 60 can have active relapses, emergence of new lesions and signs of inflammation just like people in their 20's," said lead investigator Robert Bermel, MD, fellow, Cleveland Clinic, Cleveland, Ohio. "So these older patients are potentially candidates for treatment. But clinicians have been hesitant to make the diagnosis in older people."

In this retrospective chart analysis study, the researchers identified patients who had been diagnosed with MS at or after age 60 and evaluated at a tertiary referral center over the last 5 years. The investigators reviewed each patient's chart to confirm the diagnosis and to identify clinical, laboratory, and imaging characteristics of each subject.

The researchers identified 111 cases, with a mean age at diagnosis of 64 years (range 60-76; 15 were over 70 years), a mean duration of symptoms prior to diagnosis of 9.8 years (age at symptom onset 8-71; 47 developed initial symptoms at or over 60 years). Women made up 67% of the cohort and 90% of patients were Caucasian.

Subjects presented a variety of forms of the disease: relapsing remitting (n = 37), primary progressive (n = 35), secondary progressive (n = 26), clinically isolated syndrome (n = 9), and progressive relapsing (n = 4).

Two patients with relapsing-remitting MS showed biopsy-verified MS. In those cases where an MS specialist reviewed the patient's scan, 86% of brain MRIs showed changes typical of MS, as did 80% of spine MRIs. In those cases when gadolinium was administered, 46% of subjects with relapsing-remitting MS or clinically isolated syndrome demonstrated gadolinium enhancement, and 75% of all subjects showed oligoclonal bands or elevated immunoglobulin G index.

At diagnosis, 39% of subjects were mildly disabled, as demonstrated by an Expanded Disability Status Scale (EDSS) score less than or equal to 3), and 34% needed a walking device or were non-ambulatory (EDSSgreater than or equal to 6.0).

"MS in older adults may be under-recognized and accurate diagnosis is often delayed by many years," the authors concluded in their abstract. "Some patients have symptom onset at more typical ages, but a sizable proportion have onset after age 60."

"Nearly half of relapsing patients (RRMS and CIS) presented with inflammation on MRI, which suggests that the disease course is dependent upon the inflammatory component of MS and not just age," they wrote.

"We now believe now that age should not bear upon diagnosis," Dr. Bermel added.

Kind of on the same line

Outcome not always worse for late-onset MS
Sat Oct 7, 2006 2:00 AM BST
By Will Boggs, MD

NEW YORK (Reuters Health) - Individuals who develop multiple sclerosis (MS) later in life do not always have worse outcomes than those who develop the disease in early adulthood, according to a report in the journal Neurology.

It has been assumed that patients who first develop MS symptoms after around 50 years of age have a poorer prognosis than those diagnosed earlier in life, Dr. Helen Tremlett told Reuters Health. "However, our study indicates that this is not necessarily the case."

Tremlett and Dr. Virginia Devonshire from the University of British Columbia, Vancouver, Canada examined the prognosis and prognostic factors among 132 patients with MS first diagnosed at age 50 or older (late onset), and 2,603 patients with first symptoms between age 16 and 49 (adult onset).


Motor and brain symptoms were more often the first sign of MS in the late-onset group, the authors report, whereas sensory symptoms and optic neuritis were more common in the adult-onset group.

Although disease progression was significantly faster in the late-onset group (16.9 years) than in the adult-onset group (27.7 years), the results indicate, patients in the adult-onset group were significantly younger (58.4 years) than patients in the late-onset group (71.2 years) when they reached the same level of disability.

A primary progressive course was associated with more rapid progression in patients with late-onset MS and sensory symptoms were associated with a slower progression, the researchers note.

Among patients with adult-onset MS, those who had motor and brain symptoms as the first sign of illness had a more rapid disease progression. In this group, progression was slower for women and those with sensory symptoms and optic neuritis at diagnosis.

"Once the disease course was determined (i.e., relapsing or primary progressive MS) there was little difference in prognosis between late-onset or adult-onset MS," Tremlett said.

With relapsing-remitting MS, a partial or total recovery occurs after exacerbations. Most MS patients, about 85 percent, initially begin with this subtype. With primary progressive MS, symptoms begin and usually do not remit. This subtype affects about 10 percent of people with MS.

These findings have "real implications" for patients first seen for MS late in life, she continued. "Contrary to what we thought before, the prognosis...is likely to be the same as someone with adult-onset MS (once the presence of relapsing or primary progressive MS has been determined)."

Relapsing/remitting MS has a less rapid progression than does progressive MS.

"Our data do not justify recommending a different treatment approach in late-onset MS, other than on a case by case basis," the authors conclude.


SOURCE: Neurology, September 2006.

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Bob, I think we are learning that a lot of the pre-conceived notions we had about MS aren't true. Your wife is doing well right now and hopefully they are going to find some great treatments before you even have to worry about any of that. I'm hopeful of that.