Abstract Details

Title Differential Diagnosis in Late Onset Multiple Sclerosis

Topic Multiple Sclerosis

Presentation(s) P1 - Poster Session 1 (5:30 PM-6:30 PM)

Poster/Presentation
Number 15-060

Objective To identify clinical-radiological characteristics of patients consulting with suspected Late Onset
Multiple Sclerosis (LOMS).

Background LOMS is defined by clinical presentation after 50 years of age, being less than 12% of MS
population. Diagnosis is challenging considering the broad spectrum of differential diagnoses
proposed for white matter lesions in this subgroup of patients; thus, misdiagnosis is frequent.
Finally, there is scarce evidence about prognosis and treatment of these patients.

Design/Methods Patients presenting first symptoms after 50 years of age, consulting in a tertiary neurological center
in Buenos Aires, Argentina, from January/2011 to September/2018 referred with previous diagnosis
of MS, white matter lesions or demyelinating disorders, were included. Demographic, clinical MRI
and oligoclonal-bands (OCB) characteristics were analyzed with parametric and non-parametric
tests.

Results We included 153 patients with late onset symptoms: 85 were MS and 67 had other differential
diagnosis. The most frequent diagnosis was demyelinating disorders not MS or NMOSD (n=30),
followed by microvascular damage due to unspecific white matter lesions (n=25).
26 patients (36%) were previously misdiagnosed with MS diagnosis (not fulfilling MS criteria) and 7
patients were already on disease modifying drugs. The cost of mistreated patients was
estimated in USD 7.184.200.
Among the patients who met criteria for the diagnosis of LOMS myelitis was the most frequent
presentation (37%).
On MRI analysis, corpus callosum lesions and periventricular demyelinating plaques (“Dawson-
finger signs supported MS diagnosis”) were the only specific findings bringing statistically significant
information to differentiate MS from other diagnosis. Positive OCB were useful to differentiate
demyelinating disorders from non-demyelinating etiologies.

Conclusions LOMS diagnosis is challenging, being necessary a detailed clinical history, physical exam and MRI
description, in order to avoid misdiagnosis and unnecessary treatment.
This is the largest LOMS specific case series from Latin-America, bringing important information
about this subgroup of patients, applicability of MS diagnostic criteria and differential diagnosis.

Authors/Disclosures
Florencia Yorio PRESENTER	No disclosure on file
Mariano Marrodan, MD (Institute for Neurological Research Raul Carrea. Fleni)	Dr. Marrodan has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Marrodan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck, Astra Zeneca, Gador, Biogen, Roche and Novartis.
Mauricio F. Farez, MD (FLENI)	Dr. Farez has received personal compensation for serving as an employee of Entelai. Dr. Farez has stock in Entelai. The institution of Dr. Farez has received research support from Fundación Sadosky.
Jorge D. Correale, MD (Institute for Neurological Research)	Dr. Correale has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Correale has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Correale has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Correale has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Correale has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi-Genzyme. Dr. Correale has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for ROche. Dr. Correale has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Correale has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Correale has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Correale has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi-Genzyme. The institution of Dr. Correale has received research support from Merck. The institution of Dr. Correale has received research support from Biogen. The institution of Dr. Correale has received research support from Novartis .

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