Pediatric Multiple Sclerosis with Primary Progressive Course—Report of a Retrospective Cohort Study in Iran

Abstract

The aims of this study were to suggest the rate of primary progressive (PP) subtype of pediatric onset multiple sclerosis (MS) in Isfahan, Iran, and describe its clinical and paraclinical features. The data of patients were retrieved from Isfahan MS Society (IMSS) database from April 2003 to August 2011. Among 3,843 MS patients of Isfahan who have been registered in IMSS, 260 patients had onset symptom when younger than the age of 18 years, of whom, 11 patients had a PP course (4.23%). The mean age at onset in pediatric primary progressive multiple sclerosis (PPMS) was 16 years (range: 13 to 17) with female preponderance (2.66:1) and disease duration of 4.73 ± 3.03 years. Ataxia was the most frequent initial symptom (7/11). Additionally, the mean Expanded Disability Status Scale and progression index was 4.31 ± 0.60 and 1.50 ± 1.21, respectively. Cerebrospinal fluid analysis showed oligoclonal immunoglobulin G bands in seven patients. Magnetic resonance imaging (MRI) demonstrated periventricular lesions in all 11 patients and spinal lesions in 9 patients. Exposure to parental smoking was recorded in seven individuals. In conclusion, PPMS is an uncommon subtype of pediatric onset MS. Cerebral lesions are more common MRI findings in pediatric PPMS patients than that in adults. The course of PPMS seems to be more progressive in the pediatric population than in adults.

Unfavorable outcome of pediatric onset multiple sclerosis: Follow-up in the pediatric and adult neurology departments of one referral center, in Turkey

“…The great majority of pediatric-onset patients had a RR disease course; PP course was uncommon and consistent with others reported as 0-9% of the cases (Renoux et al, 2007;Boiko et al, 2002;Ozakbas et al, 2003;Al-Hamadani et al, 2012;Ghezzi, 2005;Etemadifar et al, 2013). Of our two PP patients, one was a 13 yearold male with ataxia and the other was a 17 year-old female with motor weakness attributed to spinal cord involvement.…”

“…Of our two PP patients, one was a 13 yearold male with ataxia and the other was a 17 year-old female with motor weakness attributed to spinal cord involvement. Etemadifar et al (2013) reviewed the clinical features of the eleven PP pediatric MS cases: mean age at onset was 16 years, 8 were female and the most frequent symptom was ataxia. The clinical course of pediatric cases is usually reported as more favourable than adults (Renoux et al, 2007;Harding et al, 2013); median time to secondary progression is approximately 10 years longer, but pediatric-onset patients are 10 years younger than adult patients when they reach the same disability score (Renoux et al, 2007;Simone et al, 2002;Harding et al, 2013).…”