Chapter 18 Multiple Sclerosis with Early and Late Disease Onset

Abstract

This chapter describes multiple sclerosis (MS) with early- and late-disease onset. The onset of symptoms of MS usually occurs between the ages of 18 and 40 years. The existence of early-onset (before age 16) and late-onset (later than age 45) MS cases is well documented, and both have some peculiarities in the disease clinical course. The course of late-onset MS (LOMS) is often primary progressive. Patients presenting with relapsing-remitting MS (RRMS) are likely to reach secondary progressive stage early. LOMS may be more degenerative in nature, with less inflammation than in younger patients. At the same time, patients adapt to the disease easier and demonstrate an apparently higher level of quality of life than do younger patients. The differential diagnosis, however, in this elderly cohort is sometimes difficult. In elderly patients the clinical history and laboratory data should be thoroughly appraised to exclude conditions more common in old age, such as vascular diseases and compressive myelopathy.