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From the Department of Medicine (Neurology [H.T., V.D.] and Health Care and Epidemiology [H.T.]), University of British Columbia, Vancouver, Canada.
Address correspondence and reprint requests to Dr. Helen Tremlett, Department of Medicine (Neurology), Rm. S159, 2211 Wesbrook Mall, University of British Columbia, Vancouver, BC V6T 2B5, Canada; e-mail: tremlett{at}interchange.ubc.ca
Objective: To describe the characteristics of late-onset multiple sclerosis (MS) (LOMS, 50+ years) vs adult-onset MS (AOMS, 16 to <50 years) and examine prognosis and associated risk factors.
Methods: Patients with definite MS, onset prior to July 1988, registered with a BCMS clinic before July 1998, with at least one Expanded Disability Status Scale (EDSS) score, were selected from the longitudinal population-based British Columbian (BC) MS database. Clinical and demographic characteristics were compared between LO and AOMS. Progression was measured as time to reach sustained EDSS 6 and potential risk factors examined were sex, disease course (primary progressive [PP] vs relapsing [R]), and onset symptoms.
Results: Of those eligible (n = 2,837), LOMS comprised 132 (4.7%), with PPMS predominating (54.5% vs 10.6% in AOMS, p < 0.0005). Motor onset symptoms were more prevalent in LOMS and sensory and optic neuropathy more prevalent in AOMS (p < 0.0005). AOMS averaged 27.7 years (95% CI: 26.3 to 29.1) to EDSS 6 from onset vs 16.9 years (95% CI: 9.0 to 24.8) in LOMS, p < 0.0005. However, AOMS was associated with a younger age at EDSS 6 (58.4 years [95% CI: 57.1 to 59.6] vs 71.2 years [95% CI: 65.2 to 77.3] in LOMS, p < 0.0005). There were no differences in progression between AO or LO for those with PPMS (p = 0.373) or R-MS (p = 0.438), although considerable variation was observed.
Conclusions: Late-onset multiple sclerosis (LOMS) is not necessarily associated with a worse outcome: first, progression in the primary progressive or relapsing patients differed little between late-onset vs adult-onset; secondly, those with LOMS were older when reaching Expanded Disability Status Scale 6. The disease course has a far greater implication for disease prognosis than the presence of LOMS.
Helen Tremlett is funded by a Don Paty Career Development Award from the MS Society of Canada and the Christopher Foundation. The BC-wide MS database was funded by an unrestricted grant from Don Paty and the MS/MRI research group. This analysis was funded by a grant from the MS Society of Canada.
Disclosure: The authors report no conflicts of interest.
Received February 24, 2006. Accepted in final form May 10, 2006.
This article has been cited by other articles:
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  H Tremlett, Y Zhao, J Joseph, V Devonshire, and the UBCMS Clinic Neurologists* Relapses in multiple sclerosis are age- and time-dependent J. Neurol. Neurosurg. Psychiatry, December 1, 2008; 79(12): 1368 - 1374. [Abstract] [Full Text] [PDF]
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 H. Tremlett, Y. Zhao, and V. Devonshire Defining the natural history of MS: the need for complete data and rigorous definitions Multiple Sclerosis, September 1, 2008; 14(8): 1142 - 1143. [PDF]
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M Koch, J De Keyser, and H Tremlett Timing of birth and disease progression in multiple sclerosis Multiple Sclerosis, July 1, 2008; 14(6): 793 - 798. [Abstract] [PDF]
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 A. D. Sadovnick, P. Duquette, B. Herrera, I.M.L. Yee, and G. C. Ebers A timing-of-birth effect on multiple sclerosis clinical phenotype Neurology, July 3, 2007; 69(1): 60 - 62. [Abstract] [Full Text] [PDF]
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