Characteristics of Children and Adolescents With Multiple Sclerosis

Abstract

OBJECTIVES: To describe the demographic and clinical characteristics of pediatric multiple sclerosis (MS) in the United States.METHODS: This prospective observational study included children and adolescents with MS. Cases were evaluated across 9 geographically diverse sites as part of the US Network of Pediatric MS Centers. RESULTS:A total of 490 children and adolescents (324 girls, 166 boys) were enrolled; 28% developed symptoms before 12 years of age. The proportion of girls increased with age from 58% (<12 years) to 70% (≥12 years). Race and ethnicity as self-identified were: white, 67%; African American, 21%; and non-Hispanic, 70%. Most (94%) of the cases were born in the United States, and 39% had 1 or both foreign-born parents. Fifty-five percent of cases had a monofocal presentation; 31% had a prodrome (most frequently infectious), most often among those aged <12 years (P < .001). Children aged <12 years presented more commonly with encephalopathy and coordination problems (P < .001). Sensory symptoms were more frequently reported by older children (ie, those aged ≥12 years) (P < .001); 78% of girls had MS onset postmenarche. The initial Expanded Disability Status Scale score for the group was <3.0, and the annualized relapse rate was 0.647 for the first 2 years. Interval from symptom onset to diagnosis and from diagnosis to initiation of disease-modifying therapy was longer among those <12 years of age.CONCLUSIONS: Pediatric MS in the United States is characterized by racial and ethnic diversity, a high proportion of children with foreign-born parents, and differences in clinical features and timing of treatment among those <12 years of age compared with older children. Dr Belman conceptualizated and designed the study in addition to the acquisition of data, analysis, interpretation of the data, and drafting and revising the manuscript; Drs Krupp, Chitnis, Ness, Gorman, and Weinstock-Guttman carried out the acquisition of data, interpretation of data, and revising the manuscript; Mr Olsen carried out the statistical analysis, interpretation of data, and revising the manuscript; Dr Waubant carried out the acquisition of data, design of the study, interpretation of data, and revising the manuscript; Dr Rodriguez carried out acquisition of the data, interpretation of data, and review of the manuscript; Drs Lotze and Aaen carried out WHAT'S KNOWN ON THIS SUBJECT: Pediatric multiple sclerosis has an incidence of ≤0.64 per 10 000 and is less common among those aged <12 years. At onset, it has an almost exclusively relapsing-remitting course. WHAT THIS STUDY ADDS:In the United States, pediatric multiple sclerosis is characterized by racial/ethnic diversity, a high proportion of children with foreign-born parents, and differences in clinical features among those <12 years of age compared with older children.by guest on May 7, 2018 http://pediatrics.aappublications.org/ Downloaded from BELMAN et alMultiple sclerosis (MS) is a central nervous system autoimmune inflammatory demyelinating disease. Generally...

Effect of puberty on multiple sclerosis risk and course

“…6 The sex ratio of these cases was one to one under age of 9 years and started to switch to a clear female predominance starting at 9 years of age, suggesting a strong effect of sex hormones on the risk to develop the disease during childhood and adolescence.…”

A Comparison of Pediatric- and Adult-Onset Multiple Sclerosis

“…Belman ve ark.nın, pediatrik MS özelliklerini incelemek üzere 490 pediatrik MS hastası ile yaptıkları çalışmalarında 10 yaş altında başlayan MS'lerde cinsiyet farkı izlenmez iken, başlangıç yaşı ilerledikçe özellikle de adölesan yaşlarda belirgin bir kadın cinsiyet baskınlığına dikkat çekilmiştir. 13 Dikkat çeken bu dönemsel farklılık, MS patofizyolojisinde hormonal etkilerin varlığını kanıtlar niteliktedir. Çalışmamızda, 12 yaş altında hasta sayısının yetersizliği nedeni ile prepubertal dönem ile ilgili karşılaştırmalar yapılamamıştır.…”

“…Belman ve ark.nın çalış-masında bu oran, pediatrik yaş için %55 olarak bildirilmiştir. 13 Hem pediatrik hem de erişkin başlangıçlı MS hastalarında en sık başlangıç, supratentoryal tutulumla ilişkili klinik bulgular idi. Bunu; pediatrik başlangıçlı MS'lerde beyin sapı tutulumu, ardından optik sinir tutulumu alır iken erişkin MS grubunda optik sinir tutulumu ikinci, beyin sapı tutulumu üçüncü sırada yer almakta idi.…”

Intravenous Immunoglobulin for Relapsing-Remitting Multiple Sclerosis Treatment: A Case Report and Literature Review

“…IVIG can presently not be chosen as a first-line treatment in relapsing-remitting MS, but is a valuable alternative for patients, who show contraindications or are unwilling to take the approved medications due to frequent injections [21]. Since the younger patient group exhibits clinical features distinct from the older children, and have a longer time to diagnose and time to begin DMT (disease-modifying therapy), early diagnosis and treatment is important [22].…”