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• W2000490878 abstract "La esclerosis múltiple de comienzo tardío (EMCT) es una entidad infrecuente y no bien caracterizada, que suele plantear dificultades diagnósticas. Estudio retrospectivo de una serie hospitalaria de EMCT (primer síntoma a partir de los 50 años). Se estudiaron factores demográficos, síntomas iniciales, retraso diagnóstico, grado de discapacidad en el momento del diagnóstico, formas clínicas evolutivas y hallazgos en estudios de LCR, PEV y RM. Se incluyeron 18 pacientes (12 mujeres y 6 varones) con EMCT (4,8% del total de la serie estudiada). Los síntomas iniciales mas frecuentes fueron déficits motores (33%), de afectación de múltiples sistemas (33%) y cerebelosos (16%). Las formas clínicas evolutivas (todos los casos con un seguimento mínimo de 5 años tras el diagnóstico) fueron: EM-PP (62%), EM-SP (22%) y EM-RR (16%). La EDSS en el momento del diagnóstico era superior a 4 en un tercio de los pacientes; el retraso diagnóstico superó los 5 años en dos tercios de los casos. El estudio de RM cerebral resultó anormal y compatible con EM en todos los pacientes y cumplía criterios de Barkhof en 12 (67%). Las BOC resultaron positivas en el 64% de los pacientes en los que fueron determinadas; los PEV estaban alterados en el 73% de los casos estudiados. Los diagnósticos erróneos previos mas frecuentes fueron patología cerebrovascular y mielopatía espondiloartrósica cervical. La EMCT suele manifestarse con déficits motores o de múltiples sistemas, que progresan desde su inicio; se diagnostica con retraso, cuando hay ya un grado de discapacidad importante. El estudio de RM cerebral y medular, en conjunción con los PEV y BOC en el LCR facilita su diagnóstico. Patología cerebrovascular isquémica y mielopatía cervical son los diagnósticos erróneos más habituales. Late onset multiple sclerosis (LOMS) is an unusual entity, poorly characterised and difficult to diagnose. To study a series of patients with LOMS (presentation of the first symptom of disease after the age of 50 years). In this retrospective study we review demographic characteristics, first onset symptom, diagnostic delay, disability at the time of diagnosis (EDSS), disease course and findings in SCF, VEP and MRI studies. We included 18 patients (12 F and 6 M) with LOMS (4.8% of the total). The most frequent first symptoms were motors deficits (33%), multisystem deficits (33%) and cerebellum disorder (16%). Clinical course (all the cases with a minimal follow-up of 5 years after the diagnosis): primary progressive-MS (62%), secondary progressive-MS (22%), relapsing-remitting-MS (16%). The initial EDSS score was higher than 4 points in one third of patients and diagnosis delay was over 5 years in two thirds of cases. The cerebral MRI study was abnormal and compatible with MS in all patients and fulfilled the Barkhof criteria in 12 (67% of cases). Oligoclonal IgG bands were positive in the 64% of patients in the CSF study and VEP were abnormal in the 73%. The most frequent wrong diagnoses were cerebrovascular disorders and spondyloarthritic cervical myelopathy. LOMS course is often primary, progressive and motor and multisystem symptoms are the most frequent. The diagnosis is usually delayed and when it is made patients have a high disability score. The findings of cerebral and spinal MRI, CSF and VEP studies are of high diagnostic yield. Cerebrovascular disorders and spondyloarthritic cervical myelopathy are the most important entities in the differential diagnosis of LOMS." @default.
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• W2000490878 date "2011-06-01" @default.
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• W2000490878 title "Esclerosis múltiple de comienzo tardío" @default.
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• W2000490878 doi "https://doi.org/10.1016/j.nrl.2010.09.008" @default.
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