Later onset of MS does not necessarily
lead to worse outcome: University of British Columbia study
View
or print this bulletin in its original format.
Medical Update Memo
January 4, 2007
SUMMARY
Developing MS as an older adult (50 plus years
old) does not necessarily mean more disability,
according to researchers at the University
of British Columbia. The study by Helen Tremlett,
PhD, and Virginia Devonshire, M.D., was published
in the October 2006 issue of Neurology. The
results from this population-based study
perhaps suggest that treatment options for
late-onset MS should not be different than
the usual treatment approach once the disease
course is determined. Dr. Tremlett is the
recipient of an MS Society of Canada Dr.
Donald Paty Career Development Award.
DETAILS
While MS is usually diagnosed in people aged
15 to 40 years old, it can also develop in
children and in adults aged 50 years and
older. Previously, the development of MS
at an older
age, especially in men, was believed to lead
to a worse outcome, which might call for
immediately beginning aggressive therapy.
In this study
published in the October 2006 issue of Neurology (2006;67:954-959), Drs. Tremlett and Devonshire
used the British Columbia database to review
the disease course of 2,837 people with definite
MS registered at the MS Clinic at the University
of British Columbia before July 1998.
Of those eligible for the study, 132 (4.7
percent) had late-onset MS (LOMS) defined
as disease
onset at 50 years or older. In this group,
54.5 percent had primary-progressive MS,
compared to just 10.6 percent in the adult-onset
MS
(AOMS) group. There were no gender differences
between the LOMS and AOMS groups when their
disease courses were examined separately.
The LOMS group with a relapsing-remitting
disease
course from onset was 76.7 percent women,
compared to 72.7 percent in the AOMS group
with relapsing-remitting
MS. For those with primary-progressive
MS, 50 percent of those in the LOMS group were
women, compared to 53.4 percent were in
the
AOMS group.
The researchers used as a measure of disease
progression the time that it took people
to reach 6.0 on the Expanded Disability
Status Scale (EDSS), which is essentially
defined
as needing a cane, crutch or brace to
walk. The disease progression differed between
the
adult and late-onset MS groups. It took
27.7 years (median) for the AOMS group
to reach
EDSS 6.0 from onset compared to 16.9
years
(median) in the LOMS group. However,
AOMS group was significantly younger when they
reached
EDSS 6.0. They were 58.4 years compared
to 71.2 years for the LOMS group. In
addition,
for those with LOMS, a primary-progressive
course was associated with a more rapid
progression
to EDSS 6.0 from onset. As a whole, there
was little difference in the time to
EDSS 6.0 from
onset between the AOMS and LOMS groups
with primary-progressive MS.
The researchers concluded that the type
of MS (relapsing-remitting or primary-progressive)
is a more significant factor in predisposing
a person to a more rapid disease course.
Although the authors acknowledge that
there is little
information about how people with late
onset
MS respond to therapy (and this was
never investigated in the study), these natural
history findings
indicate that a more aggressive treatment
course in those with late-onset MS
is
probably not
justified and treatment approaches
should be based on the disease course, not
age
at onset.
ASK MS Information System Code: 2.3.3.1.g
National Research Department
National Marketing and Communications Department
Back
to top
 |
