Pediatric-Onset Multiple Sclerosis: A Single Center Study

Abstract

Pediatric-onset multiple sclerosis (POMS), once thought to be rare, is now being diagnosed in increasing numbers in children. Despite improvements to diagnostic criteria, the diagnosis and management of POMS remains challenging. The aim of this study is to retrospectively describe a growing POMS patient population seen at a single center over a 13 year period. Epidemiologic, clinical, neuroimaging, laboratory features and therapeutic management and outcome data were collected and analyzed. These data support associations between MS and environmental triggers such as obesity and vitamin D deficiency. Presenting symptoms, magnetic resonance imaging and laboratory findings were consistent with the existing literature; however, the prevalence of cortical lesions and abnormal saccadic pursuit is higher than other reports. Data also demonstrate a shift in practice from first- to second-line therapies over the observed period.

A Scoping Review of Modifiable Risk Factors in Pediatric Onset Multiple Sclerosis: Building for the Future

“…The initial search resulted in 19 full-text articles that were relevant to our objective (see Figure 1 ). The search was updated on 25 May 2018, which led to the addition of 4 articles, therefore 23 articles were included in the present analysis [ 19 , 21 , 22 , 23 ]. Additional details related to demographics, disease-related information, and relevant results of all articles are available in the detailed evidence table ( Supplementary Materials Table S1 ).…”

“…Both POMS and adult-onset MS had similarly high rates of vitamin D deficiency (50%) and insufficiency (84%), with no significant differences between the two patient populations ( p = 0.81 and p = 0.91, respectively) [ 20 ]. Two additional descriptive cohort studies of POMS patients ( n = 60 [ 19 ] and n = 111 [ 23 ]) added to this growing evidence by demonstrating that 63% [ 19 ] and 68.5% [ 23 ] of their POMS cohort had low 25(OH)-vitamin D (below 30 ng/mL). More conclusively, Banwell (2011) [ 27 ] examined whether serum vitamin D status at the time of first CNS demyelination was associated with likelihood of later diagnosis with POMS in a prospective cohort study.…”

“…Three studies reported high rates of obesity in POMS patients. The first, a descriptive retrospective single center cross-sectional study of youth with POMS [ 19 ], reported that 49% of their cohort were overweight or obese, as determined by Body Mass Index (BMI) [ 19 ]. Pakpoor et al [ 14 ] (described in detail above) demonstrated that POMS youth had higher BMIs than controls ( p < 0.001), while Brenton et al (2014) (described in more detail above) sought to investigate the prevalence of obesity, as measured by BMI, in POMS versus adult onset MS.…”

“…Only two articles clearly focused on sleep as an outcome. Four of the articles addressed two modifiable lifestyle factors and thus were included in the two relevant categories [ 14 , 18 , 19 , 20 ] (see Figure 1 ). Each category was then further analyzed to determine the main conclusions drawn and the congruency of the findings.…”

Association of Obesity With Multiple Sclerosis Risk and Response to First-line Disease Modifying Drugs in Children

“…To our knowledge, the association between BMI and treatment response in pediatric MS has never been investigated before. Yamamoto et al, 37 however, did observe higher relapse rates, in general, among overweight and obese children in a study describing 60 pediatric patients with MS, but treatment response was not investigated. An association between high BMI and worse therapy response to interferon beta has been described in a small adult cohort of 86 patients.…”