Neurology and Therapy (Jul 2019)

Late Onset of Neuromyelitis Optica Spectrum Disorders

  • Yara Dadalti Fragoso,
  • Heloisa Helena Ruocco,
  • Ronaldo Maciel Dias,
  • Hideraldo Cabeça,
  • Ricardo Gonçalves,
  • Nise A. de Carvalho Sousa,
  • Caroline Vieira Spessotto,
  • Carlos Bernardo Tauil,
  • Soniza Vieira Alves-Leon,
  • Sidney Gomes,
  • Marcus Vinicius M. Gonçalves,
  • Suzana C. Nunes Machado,
  • Andrea Anacleto,
  • Eber Castro Correa,
  • Maria Lucia V. Pimentel,
  • Gutemberg Augusto C. Santos

DOI
https://doi.org/10.1007/s40120-019-0143-2
Journal volume & issue
Vol. 8, no. 2
pp. 477 – 482

Abstract

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Abstract Introduction Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune demyelinating disease of the central nervous system. NMOSD starting after the age of 50 years is considered a “late onset” (LO-NMOSD) and seems to be particularly aggressive. The objective of this paper is to present a series of 37 Brazilian patients with LO-NMOSD. Methods Retrospective data collection from medical records of patients with LO-NMOSD seen at 14 Brazilian specialized units. Results The ratio of women to men in the sample was 4.3 to 1. The patients were followed up for a median period of 4 years. Sex, age at disease onset, and ethnic background were not associated with the number of relapses or disability outcomes. Extensive longitudinal myelitis affected 86% of patients, while optic neuritis affected 70%, and brainstem syndromes were present in only 16% of these patients. Six patients are currently using some type of support for walking or are wheelchair-bound. Three have died. Therapeutic options for NMOSD were particularly complicated for these elderly patients, since medications for controlling NMOSD are, in essence, immunosuppressive. Long-term use of corticosteroids can be an issue when the patients have high blood pressure, diabetes mellitus, or dyslipidemia (conditions often seen in elderly individuals). Conclusion This series of LO-NMOSD cases highlights the importance of prompt diagnosis and treatment for these patients.

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