{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T05:36:47Z","timestamp":1777095407619,"version":"3.51.4"},"reference-count":40,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Neurology"],"published-print":{"date-parts":[[2026,5]]},"abstract":"\n Objective<\/jats:title>\n \n The objective of this study was to compare clinical features and prognosis of late\u2010onset neuromyelitis optica spectrum disorder (\n LO<\/jats:styled-content>\n \u2010\n NMOSD<\/jats:styled-content>\n , onset age \u226560\u2009years) with adult\u2010onset\n NMOSD<\/jats:styled-content>\n (\n AO<\/jats:styled-content>\n \u2010\n NMOSD<\/jats:styled-content>\n , onset age 18\u201359\u2009years), and to provide insights for individualized management in elderly patients.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Data from 748 patients with\n NMOSD<\/jats:styled-content>\n (diagnosed according to the 2015 International Panel for\n NMO<\/jats:styled-content>\n Diagnosis criteria) in the China National Registry of Neuro\u2010Inflammatory Diseases (\n CNRID<\/jats:styled-content>\n ) were analyzed. Patients were stratified into\n AO<\/jats:styled-content>\n \u2010\n NMOSD<\/jats:styled-content>\n (18\u201359\u2009years, n\u2009=\u2009617) and\n LO<\/jats:styled-content>\n \u2010\n NMOSD<\/jats:styled-content>\n (\u2265\u200960\u2009years, n\u2009=\u2009131). Demographics, clinical manifestations, imaging, treatments, and outcomes were compared using appropriate statistical methods including Kaplan\u2013Meier survival curves and Cox proportional hazards regression.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n LO<\/jats:styled-content>\n \u2010\n NMOSD<\/jats:styled-content>\n showed distinct traits: a lower female predominance (76.34% vs 86.55%), higher transverse myelitis (\n TM<\/jats:styled-content>\n ) incidence at onset (57.36% vs 40.17%), elevated annualized relapse rate (\n ARR<\/jats:styled-content>\n ; 0.52\u2009\u00b1\u20090.03 vs 0.38\u2009\u00b1\u20090.01), and accelerated disability (median Expanded Disability Status Scale [\n EDSS]<\/jats:styled-content>\n 4.75 vs 3.0).\n TM<\/jats:styled-content>\n \u2010predominant relapses (39 of 45, 86.67% in\n LO<\/jats:styled-content>\n vs 96 of 148, 64.86% in\n AO<\/jats:styled-content>\n ) contributed significantly to disability. Kaplan\u2013Meier analysis showed\n LO<\/jats:styled-content>\n \u2010\n NMOSD<\/jats:styled-content>\n had a higher risk of relapse (hazard ratio [\n HR]\u2009=<\/jats:styled-content>\n \u20091.932, 95% confidence interval [CI]\u2009=\u20091.427\u20132.615), disability (\n HR\u2009=<\/jats:styled-content>\n \u20093.192, 95% CI\u2009=\u20091.932\u20135.274) and reaching visual acuity (\n VA<\/jats:styled-content>\n ) \u226420 of 30 (\n HR\u2009=<\/jats:styled-content>\n \u20093.523, 95% CI\u2009=\u20091.585\u20137.828). Cox regression confirmed that onset age \u226560\u2009years was an independent risk factor for relapse (\n HR\u2009=<\/jats:styled-content>\n \u20092.05, 95% CI\u2009=\u20091.60\u20132.59), disability (\n HR\u2009=<\/jats:styled-content>\n \u20093.16, 95% CI\u2009=\u20092.14\u20134.62), and reaching\n VA<\/jats:styled-content>\n \u226420 of 30 (\n HR<\/jats:styled-content>\n 3.26, 95% CI\u2009=\u20091.83\u20135.48).\n <\/jats:p>\n <\/jats:sec>\n \n Interpretation<\/jats:title>\n LO\u2010NMOSD is characterized by myelitis\u2010predominance with recurrent spinal cord involvement, high risk of relapses, and severe disability. It thus underscores the need for heightened clinical attention, with rigorous monitoring that balance safety and efficacy for elderly patients with NMOSD. ANN NEUROL 2026;99:1139\u20131151<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/ana.78146","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T12:30:19Z","timestamp":1767961819000},"page":"1139-1151","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Myelitis\u2010Predominant Aggressive Phenotype: Unveiling Unique Patterns of Late\u2010Onset Neuromyelitis Optica Spectrum Disorders"],"prefix":"10.1002","volume":"99","author":[{"given":"Ya\u2010Lan","family":"Pu","sequence":"first","affiliation":[{"name":"Department of Neurology Langzhong People's Hospital Nanchong Sichuan China"},{"name":"Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin\u2010Zhou","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Neurology The First Affiliated Hospital of Chongqing 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