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% (â„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 â„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 â€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...