People typically develop multiple sclerosis between ages 20 and 40, but late-onset MS affects those 50 years and older. Your doctor can best diagnose and advise on possible treatments, such as medications or rehabilitation.
If you have multiple sclerosis (MS), you’re among the more than 2.3 million people worldwide who share this diagnosis. While there isn’t a cure for the condition, treatments that slow MS’s progression and help to reduce symptoms are available.
MS is a disease of the central nervous system (CNS). With MS, one or more parts of the brain, optic nerves or spinal cord — all part of the CNS — become inflamed. When this happens, the nerves’ protective covering, known as myelin, suffers damage. This damage shows up in MS symptoms ranging from difficulty concentrating to muscle spasms. There are a number of other symptoms, some more common than others.
Typically, people are diagnosed with multiple sclerosis (MS) between the ages of 20 and 40, but late-onset MS (LOMS) begins to affect people ages 50 and older. The disease’s progression is usually faster in LOMS.
There are 4 disease courses, or stages, of MS development:
- Clinically isolated syndrome (CIS): This occurs when symptoms first appear and last for at least 24 hours. Symptoms result from myelin damage in the CNS, but not everyone who gets CIS develops MS. There is only 1 area of MS inflammation and the symptoms correspond to that region.
- Relapsing-remitting MS (RRMS): A type characterized by attacks, also called relapses, of new or increasing neurological symptoms. Relapses are followed by partial or complete remissions, or recovery.
- Secondary progressive MS (SPMS): This begins as RRMS but gradually worsens over time. Not all cases of RRMS will transition into SPMS.
- Primary progressive MS (PPMS): This MS disease is defined by gradually worsening neurologic functions from the time symptoms first appear. LOMS often follows this course.
Adult-onset MS (AOMS) is usually diagnosed in adults ages 20 to 40, but MS can also develop in older adults, teens, and, in rare cases, children.
Children with pediatric MS usually have CIS or RRMS. Children with MS usually recover fully, and children with RRMS usually recover from episodes more quickly and with fewer symptoms during remission than adults who are diagnosed with this form of MS.
Pediatric MS is hard to diagnose because it’s similar to acute demyelinating encephalomyelitis (ADEM). This is a similar condition, but has more serious consequences than MS and can cause severe disability at a young age.
LOMS, which is when symptoms first appear in adults over the age of 50, accounts for 10% of all MS diagnoses.
There are a number of symptoms associated with MS. Symptoms are unpredictable and may change over time. In addition, not everyone who is diagnosed with MS will experience the same symptoms.
Some common symptoms include:
- weakness
- vision changes
- fatigue
- loss of balance
- bladder dysfunction
- difficulty understanding or remembering new information
Other symptoms include:
- depression
- pain or itching
- sexual issues
- emotional changes
Typical LOMS symptoms are related to movement and visual problems.
There’s no one test used to diagnose MS. Rather, doctors will perform many tests and exams.
The following are typical diagnostic tools used by healthcare professionals:
- Neurological exam: This exam evaluates things like mental status, reflexes, coordination, and sensory function.
- Detailed clinical history: This process identifies previous symptoms, other diagnoses, and any information relevant to your health.
- Blood tests: These tests can help rule out other medical conditions that may share similar symptoms to MS.
- Magnetic resonance imaging (MRI): This scan may detect MS lesions in the brain and spinal cord.
- Oligoclonal band screening: This screening checks cerebrospinal fluid (CSF) for oligoclonal-bands (OCBs) — proteins that can indicate the presence of CNS inflammation.
- Evoked potential testing: This testing measures how quickly the brain responds to sight, sound, and touch stimulation.
A late diagnosis sometimes happens when people don’t seek medical attention for mild sensory symptoms.
To assess MS progression, doctors sometimes use the Expanded Disability Status Scale (EDSS).
This scale ranges from 0 (normal neurological exam with no disability in any functional system) to 10 (death from MS). A 2016 study in
This study looked at people over age 40 in its analysis of people with LOMS.
People who are diagnosed with MS as young adults are most likely to be diagnosed with RRMS. This is the most common disease course with around 85 percent of people with MS determined to have this type.
There are treatments available to help you manage symptoms of MS.
Rehabilitation can help to improve your energy, memory, and mobility. Types of rehabilitation your doctor may recommend include:
- physical rehab to work on improving balance, strength, and range of motion
- cognitive rehab to help with communication, organization, and attention
- occupational rehab for self-management and self-care, including doing chores and enjoying hobbies
Medications, called disease modifying therapies (DMTs), may also be used to treat MS. DMTs work to reduce the amount of relapses and slow the course of the condition.
Everyday symptoms, such as fatigue or bladder and bowel issues, are typically managed with other types of medications — not DMTs. A healthy lifestyle can also address MS symptoms and improve overall quality of life.
Your doctor will create a treatment plan based on how far your MS has progressed and how old you are at its onset.
MS is most often diagnosed between 20 and 40 years of age, but LOMS is usually diagnosed after 50 years. Disease progression may be faster in LOMS, since it’s often diagnosed as PPMS, the most serious stage of the disease.
Your doctor’s goal is to reach an accurate diagnosis after tests including a neurological exam, clinical history, MRI, OCB screening, and evoked potential testing. After the diagnosis, you and your doctor can decide on a treatment plan that’s right for you.
SOURCES:
Alroughani R, et al. (2016). Is time to reach EDSS 6.0 faster in patients with late-onset versus young-onset multiple sclerosis?
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