Multiple sclerosis and related disorders · 2025
Clinical and epidemiological characteristics of late-onset neuromyelitis optica at a tertiary care hospital in Central America.
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Lizeth Pinilla, Roberto Sáenz, Bernardino Denis, Rainier Rodriguez, Ricardo Williams
Аннотация
BACKGROUND: Late-onset neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune condition affecting the central nervous system, with a higher disability burden compared to early-onset cases. Limited data exist on its clinical and epidemiological characteristics in Latin America. This study aims to describe the clinical profile and outcomes of patients diagnosed with late-onset NMOSD in a tertiary hospital in Panama.
METHODS: We conducted a retrospective descriptive study including patients diagnosed with late-onset NMOSD (≥50 years) at the Neurology Department of Dr. Arnulfo Arias Madrid Hospital from 2016 to 2023. Demographic, clinical, and diagnostic data were collected, including Expanded Disability Status Scale (EDSS) scores, MRI findings, and seropositivity for anti-aquaporin-4 (AQP4) antibodies. Treatment strategies and clinical outcomes were analyzed.
RESULTS: A total of 30 patients were included (mean age 59 ± 6.9 years, 66.7% female). Hypertension (75%) and diabetes mellitus (50%) were the most frequent comorbidities. The median initial EDSS was 7.0, with 67% of patients following a monophasic course. Anti-AQP4 antibodies were positive in 41.2%. MRI revealed spinal lesions in 84.6% of cases. Maintenance treatment included Rituximab (62.1%) and Azathioprine (37.1%), with no significant difference in clinical stability (p=0.678). One-year mortality was 10%.
CONCLUSION: Late-onset NMOSD in our cohort was associated with severe disability at diagnosis, high comorbidity burden, and frequent spinal cord involvement. Despite immunosuppressive therapy, functional outcomes remained poor. These findings highlight the need for early diagnosis and optimized treatment strategies to improve long-term outcomes, particularly in Latin American populations where epidemiological data remain limited.
METHODS: We conducted a retrospective descriptive study including patients diagnosed with late-onset NMOSD (≥50 years) at the Neurology Department of Dr. Arnulfo Arias Madrid Hospital from 2016 to 2023. Demographic, clinical, and diagnostic data were collected, including Expanded Disability Status Scale (EDSS) scores, MRI findings, and seropositivity for anti-aquaporin-4 (AQP4) antibodies. Treatment strategies and clinical outcomes were analyzed.
RESULTS: A total of 30 patients were included (mean age 59 ± 6.9 years, 66.7% female). Hypertension (75%) and diabetes mellitus (50%) were the most frequent comorbidities. The median initial EDSS was 7.0, with 67% of patients following a monophasic course. Anti-AQP4 antibodies were positive in 41.2%. MRI revealed spinal lesions in 84.6% of cases. Maintenance treatment included Rituximab (62.1%) and Azathioprine (37.1%), with no significant difference in clinical stability (p=0.678). One-year mortality was 10%.
CONCLUSION: Late-onset NMOSD in our cohort was associated with severe disability at diagnosis, high comorbidity burden, and frequent spinal cord involvement. Despite immunosuppressive therapy, functional outcomes remained poor. These findings highlight the need for early diagnosis and optimized treatment strategies to improve long-term outcomes, particularly in Latin American populations where epidemiological data remain limited.