Distinct clinical, imaging, and cerebrospinal fluid profiles in people with late-onset multiple sclerosis

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders Pub Date : 2025-03-18 DOI:10.1016/j.msard.2025.106399

Lukas Steinegger , Veronika Kana , Nathalie Nierobisch , Adham Elshahabi , Michael Weller , Marina Herwerth , Patrick Roth

{"title":"Distinct clinical, imaging, and cerebrospinal fluid profiles in people with late-onset multiple sclerosis","authors":"Lukas Steinegger , Veronika Kana , Nathalie Nierobisch , Adham Elshahabi , Michael Weller , Marina Herwerth , Patrick Roth","doi":"10.1016/j.msard.2025.106399","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Late-onset multiple sclerosis (LOMS), defined as onset after age 50, poses unique diagnostic challenges due to clinical and radiological differences from early-onset multiple sclerosis (EOMS), which typically manifests in adults between 20 and 40 years of age. Limited research on these differences hampers accurate diagnosis of LOMS. This study aims to bridge this gap by comparing clinical presentation, imaging, and cerebrospinal fluid (CSF) findings in LOMS and EOMS patients.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed clinical, MRI, and CSF data from 148 LOMS patients treated in the neuroimmunology outpatient clinic of a Swiss tertiary referral center between 2013 and 2023. A control group of 148 EOMS patients, matched by year of diagnosis, was included for comparison.</div></div><div><h3>Results</h3><div>LOMS patients, with a median onset age of 53 years (interquartile range (IQR) 51–58 years), more commonly presented with motor or multiple symptoms and a primary progressive multiple sclerosis subtype (<em>p</em> < 0.001). They were also more likely than EOMS patients (median onset age 28 years, IQR 24–33 years) to report cognitive impairment and fatigue at disease onset (<em>p</em> < 0.001). MRI analysis showed that LOMS patients had a significantly higher T2-lesion load (<em>p</em> = 0.026) but fewer Gadolinium-enhancing lesions at diagnosis (<em>p</em> < 0.001). The percentage of patients with CSF-specific oligoclonal bands was comparable between groups, whereas CSF pleocytosis was more common in EOMS patients (<em>p</em> < 0.001). Importantly, we noticed a significant delay in diagnosing multiple sclerosis in older adults likely due to misdiagnosis or difficulties in timely recognition.</div></div><div><h3>Discussion</h3><div>LOMS represents a subgroup of multiple sclerosis with unique clinical and radiological characteristics compared to EOMS. The higher T2-lesion burden and fewer Gadolinium-enhancing lesions in LOMS can pose diagnostic challenges. Recognizing these differences may enhance diagnostic accuracy and guide more effective management strategies for LOMS.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"97 ","pages":"Article 106399"},"PeriodicalIF":2.9000,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Multiple sclerosis and related disorders","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2211034825001415","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

Late-onset multiple sclerosis (LOMS), defined as onset after age 50, poses unique diagnostic challenges due to clinical and radiological differences from early-onset multiple sclerosis (EOMS), which typically manifests in adults between 20 and 40 years of age. Limited research on these differences hampers accurate diagnosis of LOMS. This study aims to bridge this gap by comparing clinical presentation, imaging, and cerebrospinal fluid (CSF) findings in LOMS and EOMS patients.

Methods

We retrospectively analyzed clinical, MRI, and CSF data from 148 LOMS patients treated in the neuroimmunology outpatient clinic of a Swiss tertiary referral center between 2013 and 2023. A control group of 148 EOMS patients, matched by year of diagnosis, was included for comparison.

Results

LOMS patients, with a median onset age of 53 years (interquartile range (IQR) 51–58 years), more commonly presented with motor or multiple symptoms and a primary progressive multiple sclerosis subtype (p < 0.001). They were also more likely than EOMS patients (median onset age 28 years, IQR 24–33 years) to report cognitive impairment and fatigue at disease onset (p < 0.001). MRI analysis showed that LOMS patients had a significantly higher T2-lesion load (p = 0.026) but fewer Gadolinium-enhancing lesions at diagnosis (p < 0.001). The percentage of patients with CSF-specific oligoclonal bands was comparable between groups, whereas CSF pleocytosis was more common in EOMS patients (p < 0.001). Importantly, we noticed a significant delay in diagnosing multiple sclerosis in older adults likely due to misdiagnosis or difficulties in timely recognition.

Discussion

LOMS represents a subgroup of multiple sclerosis with unique clinical and radiological characteristics compared to EOMS. The higher T2-lesion burden and fewer Gadolinium-enhancing lesions in LOMS can pose diagnostic challenges. Recognizing these differences may enhance diagnostic accuracy and guide more effective management strategies for LOMS.

查看原文本刊更多论文

迟发性多发性硬化症患者的独特临床、影像学和脑脊液特征

迟发性多发性硬化症（LOMS）定义为50岁以后发病，由于临床和放射学上与早发性多发性硬化症（EOMS）的差异，它提出了独特的诊断挑战，早发性多发性硬化症（EOMS）通常表现为20至40岁的成年人。对这些差异的研究有限，阻碍了LOMS的准确诊断。本研究旨在通过比较LOMS和EOMS患者的临床表现、影像学和脑脊液（CSF）检查结果来弥合这一差距。方法回顾性分析2013年至2023年在瑞士三级转诊中心神经免疫学门诊治疗的148例LOMS患者的临床、MRI和CSF数据。对照组148例EOMS患者，按诊断年份匹配，纳入比较。结果sloms患者的中位发病年龄为53岁（四分位间距为51-58岁），多表现为运动或多种症状和原发性进行性多发性硬化症亚型(p <；0.001)。他们也比EOMS患者（中位发病年龄28岁，IQR 24-33岁）更有可能在发病时报告认知障碍和疲劳(p <；0.001)。MRI分析显示，LOMS患者诊断时t2病变负荷显著增加（p = 0.026），但钆增强病变较少(p <；0.001)。具有CSF特异性寡克隆带的患者百分比在两组之间具有可比性，而脑脊液多细胞症在EOMS患者中更为常见(p <；0.001)。重要的是，我们注意到老年人多发性硬化症的诊断明显延迟，可能是由于误诊或难以及时识别。与EOMS相比，loms是多发性硬化的一个亚组，具有独特的临床和放射学特征。LOMS较高的t2病变负担和较少的钆增强病变给诊断带来了挑战。认识到这些差异可以提高诊断的准确性，并指导更有效的LOMS管理策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Multiple sclerosis and related disorders CLINICAL NEUROLOGY-

CiteScore

5.80

自引率

20.00%

发文量

814

审稿时长

66 days

期刊介绍： Multiple Sclerosis is an area of ever expanding research and escalating publications. Multiple Sclerosis and Related Disorders is a wide ranging international journal supported by key researchers from all neuroscience domains that focus on MS and associated disease of the central nervous system. The primary aim of this new journal is the rapid publication of high quality original research in the field. Important secondary aims will be timely updates and editorials on important scientific and clinical care advances, controversies in the field, and invited opinion articles from current thought leaders on topical issues. One section of the journal will focus on teaching, written to enhance the practice of community and academic neurologists involved in the care of MS patients. Summaries of key articles written for a lay audience will be provided as an on-line resource. A team of four chief editors is supported by leading section editors who will commission and appraise original and review articles concerning: clinical neurology, neuroimaging, neuropathology, neuroepidemiology, therapeutics, genetics / transcriptomics, experimental models, neuroimmunology, biomarkers, neuropsychology, neurorehabilitation, measurement scales, teaching, neuroethics and lay communication.