Clinical Characteristics Of Very Late Onset Neuromyelitis Optica Spectrum Disorders

Objective:According to the age of onset,NMOSDs（Neuromyelitis optica spectrum disorders）can be divided into Early-onset neuromyelitisoptica spectrum disorders（EO-NMOSDs,<50 years old）,Late-onset neuromyelitisoptica spectrum disorders（LO-NMOSDs,50-69 years old）,and Very late-onset neuromyelitisoptica spectrum disorders（VLO-NMOSDs,≥70 years old）^[1].Few cases of VLO-NMOSDs have been reported,mainly case reports^{[2 3]}.The clinical characteristics of patients with VLO-NMOSDs are still unclear,and further in-depth studies with a large sample size are needed.The aim of this study is to analyze the clinical characteristics of patients with VLO-NMOSDs,LO-NMOSDs and EO-NMOSDs.Methods:A total of 83 patients with NMOSDs admitted to the Department of Neurology,the First Affiliated Hospital of China Medical University from January 2021 to November 2022 were enrolled.According to the age of onset,they were divided into early-onset NMOSDs（EO-NMOSDs）.Late-onset NMOSDs（LO-NMOSDs）,and very late-onset NMOSDs（VLO-NMOSDs）,The gender composition,core clinical symptoms of the first attack,EDSS score,brain and spinal cord MRI findings,laboratory examination and treatment plan were compared between VLO-NMOSDs patients and other groups.To summarize the clinical characteristics of Chinese patients with VLO-NMOSDs.Results:1.Compared with EO-NMOSDs group,VLO-NMOSDs group had a higher incidence of acute myelitis alone and a lower incidence of optic neuritis alone（P=0.045,P=0.008）.2.The EDSS score of VLO-NMOSDs group was higher than that of EO-NMOSDs group and LO-NMOSDs group（P=0.000,P=0.033）,and the relative disability was higher.3.VLO-NMOSDs were more likely to involve the thoracic spinal cord and less likely to involve the brain than EO-NMOSDs（P=0.001,P=0.026）.Conclusion:This study found that patients with VLO-NMOSDs are more likely to have acute myelitis at the onset,and have higher severity and disability.Patients with VLO-NMOSDs are more likely to have thoracic spinal cord involvement,and less likely to have brain involvement.