Very late onset multiple sclerosis likely associated with restless legs syndrome. A case report.

Introduction: We describe the case of P.R., a 84 years-old woman suffering from Restless Legs Syndrome since 2002 and Multiple Sclerosis since 2007. Case report: MS clinical onset was characterized by walking difficulties and abnormal sensitivity in lower limbs especially in the evening. Then other symptoms added: dysesthesies on the left leg and arm and left emitrunk, visual acuity reduction, blurred vision and fatigue. She first performed an electromyographic and polysomnographic examination, with a diagnosis of Restless Legs Syndrome. At the MRI of the brain, multiple lesions in white matter were detected, unconsistent with a vascular disease but suggestive for a demielinating disease. The patient was admitted to hospital and the lumbar puncture was performed: the analysis of the cerebrospinal fluid showed 11 oligoclonal bands. VEPs, SSEPs, Trigeminus-facial reflex and a new brain MRI were performed later, and confirmed the MS. The patient regularly performed medical examinations and brain MRI to keep the condition under control. She claimed light and slow worsening of the ambulation, but her brain MRI didn’t show any increase of lesions burden nor pathological enhancement. Due to her age, she doesn’t take DM therapy for multiple sclerosis, the only drugs being represented by symptomatic agents. Discussion: The association between multiple sclerosis and restless leg syndrome has been already described especially in old patients, but the onset of MS in elderly in unusual and it’s described as LOMS (late onset multiple sclerosis), with an onset after the age of 50 with typical clinical and neuroradiological features: the presence of motor and cerebellar symptoms seem to be more frequent in this sub-group of patients, as well as low frequency of Gadolinium enhacement lesions. This could be related to a more degenerative and less inflammatory form of the disease. Moreover, in this late onset patients is essential the different diagnosis with other diseases interesting the white matter, i.e. vascular, infective, paraneoplastic, metabolic diseases or nutritional deficiencies, which could confound the true diagnosis. Conclusions: The present case report is interesting for the association between RLS and MS, but also as this comorbidity occurs I a very old patient, who could be described as a patient with a “very late onset multiple sclerosis”.