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DGDispatch

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.

[Presentation title: Active Inflammation Is Common in Very Late Onset Multiple Sclerosis: Characteristics of 111 Patients. Abstract P575]