The Comparison Of Clinical Characteristics And Treatment Prognosis With Late Onset Multiple Sclerosis And Adult Onset Multiple Sclerosis

Objectives:We retrospectively analyzed and followed the patients with late onset multiple sclerosis and adult onset multiple sclerosis who were in our neurology hospital,comparing and analyzing the differences with the mode of onset,precipitating factor,clinical manifestations,imaging features,cerebrospinal fluid examination,etc;Treatment efficacy at acute stage and in the longterm was assessed by EDSS and progression index.We compared disease progression,intending to provide the basis for clinical diagnosis and treatment.Methods:We selected MS patients in our hospital by inclusion and exclusion criteria,then divided those people into LOMS group and AOMS group according to age.The clinical data of gender,disease duration,complicated diseases, predisposing factors,age of first onset,mode of onset,the first clinical manifestation,course of the new manifestations,cerebrospinal fluid examination,imaging,etc.are collected and compared.Then we selected those treated with methylprednisolone or combined gamma globulin in our hospital and follow-up successful,for each patient,EDSS score and PI were calculated pre-treatment,before discharge and during the follow-up at least two years after treatment.Results:The study included 67 AOMS patients and 32 LOMS patients.Gender,disease duration,with or without complicated diseases and predisposing factors and mode of onsetwith the patients of the two groups were compared,the difference was not statistical significant( P > 0.05).Motor dysfunction of first onset,single symptomat onset and sphincterdys function of new emergence in course were more common in LOMS group than in AOMS group,multiple symptomsat onset was more common in AOMS group than in LOMS group,the differences were statistical significant(P<0.05).Sensation disorders of first onset was more often present in AOMS group than in LOMS group,no statistical significant difference(P>0.05).There were 58 cases and 29 cases respectivelyin AOMS group and LOMS group with brain magnetic resonance imaging,41 cases and 25 cases with spinal cord magnetic resonance imaging.The two groups are more common in the brain and spinal cord lesions,patients in LOMS group with brain and spinal cord lesions were 47cases(81.0%),26cases(63.4%)respectively,and in LOMS group were 20 cases(69.0%),22 cases(88.0%).Spinal cord lesions was more common in LOMS group than in AOMS group,the difference was statistical significance(P<0.05).There were 45 cases and 23 cases respectivelyin AOMS group and LOMS group with cerebrospinal fluid examination.In AOMS group,CSF cell count(×106/L)and protein concentration(g/L) were3.96±4.21,0.32±0.26 respectively,and in LOMS group were 5.48±4.99,0.38±0.32 respectively,no statistical significant difference(P>0.05).AOMS group and LOMS group were 31 cases and 17 cases respectively followed up successfully.In methylprednisolone group,there were 19 AOMS patients and 7 LOMS patients,and in methylprednisolone combined with gamma globulin group,there were 12 AOMS patients and 10 LOMS patients.Whether in methylprednisolone group or in methylprednisolone combined with gamma globulin group,disease duration,EDSS before the treatment and follow-up time of AOMS patients and LOMS patients were not statistical significance(P>0.05).In methylprednisolone group,the difference between pre-treatment and before discharge in AOMS group was greater than LOMS group,statistical significant(P<0.05).In methylprednisolone combined with gamma globulin group,the difference between pre-treatment and before discharge in AOMS group was greater than LOMS group,statistical significant(P<0.05).In the two treatment groups,comparison of long-term efficacy evaluation of AOMS group and LOMS group,the difference was not meaningful(P>0.05).In methylprednisolone group,PI value of AOMS group and LOMS group were 0.45±0.17 and 0.66±0.21 respectively,PI value in AOMS group is higher than in LOMS group,the difference was statistical significant(P<0.05).In methylprednisolone combined with gamma globulin group,PI value of AOMS group and LOMS group were 0.41±0.17 and 0.84±0.63 respectively,PI value in AOMS group is higher than in LOMS group,the difference was statistical significant(P<0.05).Conclusions:LOMS patients with motor dysfunction of first onset,single symptomat onset and spinal cord lesions were more common,and relatively faster progression,however AOMS patients with sensation disorders first onset and multiple symptomsat onset is relatively common.Acute phase efficacy with AOMS patients is significant effect than LOMS patients,however no difference in long-term efficacy,LOMS patients’ condition more likely to progress,which suggests that we should pay special attention to LOMS patients in clinical practice,and seek more aggressive treatment to inhibit disease progression.