Late-onset multiple sclerosis in Isfahan, Iran

Multiple sclerosis [MS] typically affects young adults; however, the first symptoms can occur after age 50 and is classified as late-onset MS [LOMS]. In this retrospective study, we extracted the records of 3522 MS patients [2716 females and 806 males] registered in the Isfahan MS Society [IMSS] from 2003 to 2010. Next, we searched for LOMS cases. We aimed to compare these cases with 1698 non-LOMS subjects also extracted from the IMSS database. We found 48 LOMS patients [28 females and 20 males], which gave a crude frequency of 1.36%. The frequency by sex of LOMS in males [2.4%] was significantly greater than in females [1.0%, P = 0.002]. The mean age at onset was 55.1 +/- 4.3 years. The female to male ratio of 1.4:1 in these patients was significantly lower than in non-LOMS subjects [3.37:1, P= 0.003]. The leading pattern of MS was relapsing-remitting [RR] in 62.5%, followed by primary progressive [PP] in 27.1%, and secondary progressive [SP] in 10.4%. Predominant presenting symptoms and signs were motor disturbances [35.4%], followed by brainstem [25%], optic neuritis [22.9%], and sensory related deficits [18.7%]. The mean progression index [PI] in LOMS patients [0.88 +/- 0.48] was significantly higher than in non-LOMS cases, 0.37 +/- 0.17 [P< 0.0001]. In comparing LOMS patients with the non-LOMS cohort, there was a higher frequency of the PP pattern and a higher PI in the LOMS group. In comparing other high-risk populations with the Isfahan cohort, LOMS formed a lower percentage of the total Isfahan MS population

Epileptic seizures in early-onset multiple sclerosis

Early-onset multiple sclerosis [EOMS] is defined as the first presentation of symptoms in childhood [before the age of 16 years]. EOMS occurs in about 0.4% to 10.5% of multiple sclerosis [MS] patients. In this retrospective population-based study we aimed to describe the clinical/paraclinical details and frequency of epileptic seizures in Iranian EOMS patients registered with the Isfahan Multiple Sclerosis Society [IMSS] from April 2003 to July 2010. EOMS cases were extracted from the Isfahan total MS cohort and included 3522 patients. A total of 117 EOMS patients [19 males and 98 females] with a mean age at onset of 14.2 +/- 2.0 years [range: 7-16 years] were extracted from our database [3.3% of the total cohort]. Of cases, ten [one male and nine females] had experienced at least two epileptic seizures, providing a crude prevalence of 8.5%. The frequency of epilepsy in EOMS patients [3.3%, 10/117] was significantly greater [P < 0.001] than that of non-EOMS cohort [2.0%, 71/3405]. Epileptic seizures occurred before MS onset in two patients, after MS onset in seven, and at MS onset in one as the presenting symptom of the disease. Our findings mostly indicate an excessive prevalence of epileptic seizures in Iranian EOMS patients [8.5%], which is higher than any other report concerning seizures or epileptic seizures in a large MS series. These findings might be supportive of increased prevalence of epileptic seizures in EOMS