Characteristics of pediatric multiple sclerosis: The Turkish pediatric multiple sclerosis database

Yılmaz, Ünsal; Anlar, Banu; Gücüyener, Kıvılcım; Yaramış, Ahmet; Cansu, Ali; Ünalp, Aycan; Aksoy, Ayşe; Bayram, Ayşe Kaçar; Kartal, Ayşe; Tosun, Alptekin; Serdaroğlu, Ayşe; Konuşkan, Bahadır; Sarıoğlu, Berrak; Yüzbaşı, Beste Kıpçak; Kılıç, Betül; Taskin, Birce Dilge; Bulut, Cahide; Yılmaz, Cahide; Yarar, Çoşkun; Okuyaz, Çetin; Gençsel, Çigdem; Yüksel, Deniz; Arslan, Elif Acar; Gürkaş, Esra; İncecik, Faruk; Serdaroğlu, Gül; Deda, Gülhıs; Gürbüz, Gürkan; Gümüş, Hakan; Acer, Hamit; Tekgül, Hasan; Çaksen, Hüseyîn; Per, Hüseyin; Erol, İlknur; Çarman, Kürşat Bora; Canpolat, Mehmet; Özkan, Mehpare; Direk, Meltem Çobanoğulları; Kutluk, Muhammet Gültekin; Arslan, Mutluay; Sönmez, Fatma Müjgan; Dündar, Nihal Olgaç; Koçak, Ozan; Aydın, Ömer; Toptaş, Özge; Duman, Özgür; Hergüner, Özlem; Bozkurt, Öznur; Arıcan, Pınar; Yılmaz, Sanem; Gökben, Sarenur; Işıkay, Sedat; Kumandaş, Sefer; Edizer, Selvinaz; Kurul, Semra Hız; Saygı, Semra; Teber, Serap; Güngör, Serdal; Altunbaşak, Şakìr; Haspolat, Şenay; Sezer, Taner; Yilmaz, Tuba; Yış, Uluç; Öztoprak, Ülkühan; Aydoğmuş, Ümmü; Topçu, Yasemin; Öztürk, Zeynep; Karalök, Zeynep Selen

doi:10.1016/j.ejpn.2017.06.004

Cited by 20 publications

(14 citation statements)

References 57 publications

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“…In long-term follow-up studies, EDSS scores of 4, 6, or 7 are considered milestones in terms of disability and disease progression. Permanent disability (EDSS ≥4.0) was reported by one study in only 15% of patients within 5 years follow-up; 21 , 22 however, the higher percentage in the current study could be explained by the longer follow-up period, that reached up to 20 years in some patients.…”

Section: Discussioncontrasting

confidence: 75%

“…Patients with POMS typically have relapsing-remitting course with a tendency of having more frequent relapses early in their course, whereas the primary progressive form is exceptional. 1 , 3 , 21 , 29 – 31 In our series, the overall mean ARR was 0.89; however, the mean relapse rate in the first year was significantly higher in EOPMS (1.64) vs LOPMS (1.23); which reflected the pronounced inflammatory pattern. In accordance with previous reports, none of our patients had PPMS; yet, we detected SPMS in 5.38% of our patients; which is comparable with Mikaeloff et al, 18 higher than what was reported by the German Centre of Multiple Sclerosis in Childhood and Adolescents (3/166), 30 but far lower than some previously reported percentages.…”

Section: Discussioncontrasting

confidence: 54%

“… 21 On the contrary, low rates of polyfocal presentation are reported mostly from Canada and the USA, 13 , 15 which could suggest the genetic, geographic, and/or environmental influence. 21 , 22 Additionally, ADEM-like onset could depict a challenge in the diagnosis of POMS; as ADEM followed later by a non-encephalopathic clinical event with new lesions on brain MRI consistent with MS is one of the common clinical scenarios that account for 18%–29% of patients; 23 yet, in a prospective study following the IPMSSG definitions on children with ADEM, only 6% developed MS in a 9-year follow up. 24 In our series; about 10% of our MS patients developed one encephalopathic and one non-encephalopathic event.…”

Section: Discussionmentioning

confidence: 99%

“…The frequency of presenting symptoms in our series are similar to what was reported by Belman et al; 3 however, cerebellar and brain stem involvement were the ushering symptoms in about 50% of patients in other studies. 21 – 23 , 25 The reason for this discrepancy is unclear, but it may be due to the inability of young children to accurately describe symptoms like sensory impairment, vertigo, or diplopia, or due to inconsistent definitions between different studies, some including both clinical and MRI involvement. 21 …”

Section: Discussionmentioning

confidence: 99%

“… 21 – 23 , 25 The reason for this discrepancy is unclear, but it may be due to the inability of young children to accurately describe symptoms like sensory impairment, vertigo, or diplopia, or due to inconsistent definitions between different studies, some including both clinical and MRI involvement. 21 …”

Section: Discussionmentioning

confidence: 99%

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Pediatric-onset multiple sclerosis in Egypt: a multi-center registry of 186 patients

Hamdy

Naseer

Shalaby

et al. 2018

NDT

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IntroductionAlthough the frequency of pediatric-onset multiple sclerosis (POMS) has increased in recent decades, it is still highly uncommon, which creates a need for the involvement of more registries from various clinical centers.ObjectiveTo characterize the demographic, clinical, and paraclinical features of Egyptian patients with POMS.Patients and methodsA retrospective chart review study was undertaken on 237 Egyptian patients with demyelinating events which started before the age of 18 years who attended one of five tertiary referral centers in Cairo, Egypt.ResultsMultiple sclerosis was diagnosed in 186 patients, 47 (25.27%) patients had disease onset before the age of 12 years; “early-onset pediatric multiple sclerosis (EOPMS)”. The mean age of disease onset was (14.13±2.49 years), with a female:male ratio of 1.62:1, none of the enrolled patients had a primary progressive course (PPMS), whereas 10 patients (5.38%) had a secondary progressive form. Approximately two-thirds of the patients had monofocal disease onset, and less than 10% presented with encephalopathy; most of them had EOPMS. Motor weakness was the presenting symptom in half of the patients, whereas cerebellar presentation was detected in 34.95%, mainly in EOPMS. Seizures (not related to encephalopathy) were more frequent in those with EOPMS. Initial brain magnetic resonance images were positive in all patients, with detected atypical lesions in 29.03%, enhanced lesions in 35.48%, black holes in 13.98%, and infratentorial in 34.41%. Cervical cord involvement was found in 68.28%. More than two-thirds of the patients received either immunomodulatory or immunosuppressant (IS) treatment throughout their disease course, and about half of them received their treatment within the first year from symptoms onset, with a more favorable outcome, and patients with highly active disease received natalizumab, fingolimod, or other IS.ConclusionThe results from this registry – the largest for MS in the Arab region to date – are comparable to other registries. Immunomodulatory therapies in POMS are well tolerated and efficacious and they can improve the long-term outcome in children.

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Section: Discussioncontrasting

confidence: 75%