Ti Wu

Objective: The objective of this study was to compare clinical features and prognosis of late‐onset neuromyelitis optica spectrum disorder ( LO ‐ NMOSD , onset age ≥60 years) with adult‐onset NMOSD ( AO ‐ NMOSD , onset age 18–59 years), and to provide insights for individualized management in elderly patients. Methods: Data from 748 patients with NMOSD (diagnosed according to the 2015 International Panel for NMO Diagnosis criteria) in the China National Registry of Neuro‐Inflammatory Diseases ( CNRID ) were analyzed. Patients were stratified into AO ‐ NMOSD (18–59 years, n = 617) and LO ‐ NMOSD (≥ 60 years, n = 131). Demographics, clinical manifestations, imaging, treatments, and outcomes were compared using appropriate statistical methods including Kaplan–Meier survival curves and Cox proportional hazards regression. Results: LO ‐ NMOSD showed distinct traits: a lower female predominance (76.34% vs 86.55%), higher transverse myelitis ( TM ) incidence at onset (57.36% vs 40.17%), elevated annualized relapse rate ( ARR ; 0.52 ± 0.03 vs 0.38 ± 0.01), and accelerated disability (median Expanded Disability Status Scale [ EDSS] 4.75 vs 3.0). TM ‐predominant relapses (39 of 45, 86.67% in LO vs 96 of 148, 64.86% in AO ) contributed significantly to disability. Kaplan–Meier analysis showed LO ‐ NMOSD had a higher risk of relapse (hazard ratio [ HR] = 1.932, 95% confidence interval [CI] = 1.427–2.615), disability ( HR = 3.192, 95% CI = 1.932–5.274) and reaching visual acuity ( VA ) ≤20 of 30 ( HR = 3.523, 95% CI = 1.585–7.828). Cox regression confirmed that onset age ≥60 years was an independent risk factor for relapse ( HR = 2.05, 95% CI = 1.60–2.59), disability ( HR = 3.16, 95% CI = 2.14–4.62), and reaching VA ≤20 of 30 ( HR 3.26, 95% CI = 1.83–5.48). Interpretation: LO‐NMOSD is characterized by myelitis‐predominance 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;99:1139–1151

Patients with myasthenia gravis (MG) exhibit significant heterogeneity based on age at disease onset. However, existing retrospective studies in China remain confined to single-center settings with limitations in sample size adequacy. The aim of this study was to compare clinical characteristics, treatment responsiveness, and long-term postintervention status of patients with MG across different onset ages. This was an observational, cross-sectional, multicenter, retrospective study. We reviewed the medical records of patients diagnosed with MG who were hospitalized in 3 MG centers of China from January 2012 to December 2022. Demographic information, clinical characteristics, and therapeutic data were extracted from the electronic medical record system, and responsiveness to treatment was followed up. Patients were classified into 3 age subgroups: juvenile MG (age at onset p < 0.001). Multivariable analysis identified late-onset MG (HR 0.8 [95% CI 0.69-0.91]), thymic abnormalities (HR 0.8 [95% CI 0.67-0.91]; HR 0.7 [95% CI 0.61-0.88]), and generalized MG (HR 0.8 [95% CI 0.71-0.96]) as factors associated with poorer outcomes. This large cohort study highlights distinct clinical and prognostic differences in MG by age at onset. Pubertal-onset juvenile MG and late-onset MG represent vulnerable groups, with late-onset MG demonstrating poorer prognosis.

Objective: Glial fibrillary acidic protein astrocytopathy (GFAP‐A) is a recently defined nosological form belonging to the class of autoimmune inflammatory disorders affecting the central nervous system (CNS). Here, we report the clinical and MRI characteristics, treatment, and prognosis of a GFAP‐A cohort from two centers in China.Methods: We retrospectively analyzed the data from 38 adult patients with positive GFAP antibodies and diagnosed as GFAP‐A between June 2019 and September 2024. Clinical features, semiquantitative antibody test results, MRI features, treatment approaches, and prognosis were collected.Results: Among the 38 patients, 24 were male, and the median age at disease onset was 49.5 years. The clinical phenotype included encephalomyelitis (28.9%), myelitis (23.7%), encephalitis (18.4%), meningoencephalomyelitis (18.4%), meningitis/spinal meningitis (7.9%), and peripheral neuropathy (2.6%). In enhanced MRI images, 4 (10.5%) of the patients showed enhancement of the cerebral meninges, 2 (5.3%) had enhancement of the ependyma, and 5 (13.2%) had enhancement of the spinal cord pia mater. 77.1% of the patients responded to the glucocorticoid treatment, while 65.8% had a monophasic course. Spearman correlation analysis showed that CSF‐specific oligoclonal bands were significantly correlated with 1‐year relapse (CI = 0.527, p = 0.003).Interpretation: The clinical manifestations of GFAP‐A are highly diverse, encompassing encephalitis, myelitis, and meningitis, including spinal meningitis. The enhancement of the spinal pia mater and ependyma on MRI was confirmed. Most patients exhibit a positive response to glucocorticoid therapy. The presence of CSF‐specific oligoclonal bands could potentially serve as an indicator for predicting recurrence.