Saturday, October 21, 2006

Outcome not always worse for late-onset MS

Last Updated: 2006-10-06 14:51:46 -0400 (Reuters Health)
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 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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