Multiple sclerosis with onset after age 60

The onset of multiple sclerosis (MS) after age 60 is uncommon. The clinical features of three such cases are described. Considerable diagnostic delay was seen in each case as symptoms were initially attributed to other conditions that more commonly afflict the elderly, including atypical facial pain, neuropathy, peripheral and cerebral vascular disease, arthritis, benign prostatic hypertrophy, and ischemic optic neuropathy. Although MS should be considered a diagnosis of exclusion in this age group, cerebral evoked potentials and CSF immunoglobulin studies can increase the diagnostic yield and may be helpful in the appropriate clinical context.