The State of the Art of Pediatric Multiple Sclerosis

Teleanu, Raluca Ioana; Niculescu, Adelina-Gabriela; Vladâcenco, Oana Aurelia; Roza, Eugenia; Perjoc, Radu-Stefan; Teleanu, Daniel Mihai

doi:10.3390/ijms24098251

Cited by 7 publications

(6 citation statements)

References 124 publications

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“…Epstein-Barr virus (EBV) infection is a determinant of POMS that has been extensively studied [25,26]. Vitamin D deficiency, not breastfeeding infants, pesticide exposure, smoking, air quality, and hormonal influences [18] were among the other factors [18]. Furthermore, certain risk factors seem to have a more significant impact during a particular time frame.…”

Section: Discussionmentioning

confidence: 99%

“…The presence of high BMI values in pediatric multiple sclerosis patients in their childhood and before the onset of neurological symptoms is a common occurrence [6,11,16,17]. Despite considering environmental and genetic risk factors, the connection between high BMI and increased risk of MS remains valid [18]. Regarding genetic factors, a recent study performing mendelian randomization could confirm the positive causal association between high BMI and MS, and detected as well common risk genes shared between MS and obesity, suggesting a potential pathogenetic mechanism to justify this comorbidity [16].…”

Section: Introductionmentioning

confidence: 99%

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Pediatric Onset Multiple Sclerosis and Obesity: Defining the Silhouette of Disease Features in Overweight Patients

Papetti,

Panella,

Monte

et al. 2023

Nutrients

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Obesity has been suggested as an environmental risk factor for multiple sclerosis (MS) and may negatively effect the progression of the disease. The aim of this study is to determine any correlation between overweight/obesity and the clinical and neuroradiological features at the onset of pediatric onset multiple sclerosis (POMS). Were included patients referred to the POMS Unit of the Bambino Gesù Children’s Hospital between June 2012 and June 2021. The diagnosis of MS with an onset of less than 18 years was required. For all included subjects, we considered for the analysis the following data at the onset of symptoms: general data (age, sex, functional system compromised by neurological signs, weight and height), brain and spinal magnetic resonance imaging (MRI), cerebrospinal fluid exams. We identified 55 pediatric cases of POMS and divided them into two groups according to the body mass index (BMI): 60% were healthy weight (HW) and 40% were overweight/obese (OW/O). OW/O patients experienced a two-year age difference in disease onset compared to the HW patients (12.7 ± 3.8 years vs. 14.6 ± 4.1 years; p < 0.05). Onset of polyfocal symptoms was seen more frequently in OW/O patients than in HW (72.7% vs. 21.2%; p < 0.05). The pyramidal functions were involved more frequently in the OW/O group than in the HW group (50% vs. 25%; p < 0.005). Black holes were detected more frequently in OW/O patients in onset MRI scans compared to the HW group (50% vs. 15.5%; p < 0.05). Our findings suggest that being overweight/obese affects the risk of developing MS at an earlier age and is associated with an unfavorable clinical–radiological features at onset. Weight control can be considered as a preventive/therapeutic treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pediatric Onset Multiple Sclerosis and Obesity: Defining the Silhouette of Disease Features in Overweight Patients

Papetti,

Panella,

Monte

et al. 2023

Nutrients

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“…Several recent publications have focused on the correlation between HHV-4 infection and several human lymphoproliferative cancers and autoimmune disorders, suggesting an association and possible causal link between both [46 ▪ ,67]. Of particular interest are the findings linking EBV with Multiple Sclerosis(MS) [18,19 ▪ ,62,68], where higher incidences of MS have been linked to those patients who have suffered overt IM [22,66 ▪▪ ,69] often later in life, particularly in adolescence [48 ▪ ,49 ▪▪ ,50,66 ▪▪ ]. Several pathways have been proposed to explain a possible causal link between EBV infection, particularly when it presents as IM, and MS, although irrefutable scientific proof to fully explain and support the association conclusively has yet to be produced [19 ▪ ,70].…”

Section: Epidemiologymentioning

confidence: 99%

Infectious mononucleosis: new concepts in clinical presentation, epidemiology, and host response

Naughton,

Enright,

Lucey

2024

Current Opinion in Infectious Diseases

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Purpose of the review Infectious mononucleosis (IM) is an infectious disease that presents clinically in only a small percentage of individuals despite almost universal infection with the causative agent. Here, we review the latest concepts in the clinical presentation, epidemiology, and host response of this disease. Recent findings Several recently published papers/reviews describe IM as a condition caused by one of several etiologic agents including, cytomegalovirus (HHV-5), Roseola virus (HHV-6) and Toxoplasmosis amongst others; this review focuses on IM as solely caused by the human herpes virus 4 (HHV-4). Since the initial discovery of the virus in the 1960s and its subsequent discovery as the primary etiologic agent for IM it has been associated with several human cancers and autoimmune disorders. Recent published findings show a correlation between HHV-4 and the autoimmune disorder, multiple sclerosis (MS), suggesting earlier IM could possibly act as a causative factor. Considering the important links being made with IM to so many cancers and autoimmune disorders it is surprising that a standard investigative procedure has yet to be determined for this disease. A standard approach to the investigation of IM would ensure more cases are diagnosed, particularly atypical cases, this would benefit epidemiological studies, and more immediately help practitioners distinguish viral from bacterial throat infections, enabling them to treat accordingly. Summary The understanding of the latest concepts in clinical presentation, epidemiology and host response to IM would benefit greatly from the introduction of a standard procedure for its investigation and diagnosis.

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“… 1 , 4 POMS is characterized by chronic multiphasic inflammation with high relapse rates, potentially impacting cognitive and physical development. 5 In contrast, only 30% to 50% of initial CNS demyelinating events in MOGAD children are multiphasic. 6 Diagnosis of POMS allows early initiation of preventive disease-modifying therapies (DMTs), while evidence-based treatment guidelines for MOGAD are limited.…”

Section: Introductionmentioning

confidence: 99%

“…The McDonald criteria, 7 which have been validated to diagnose MS in pediatric patients, 5 , 8 – 10 are more cautiously employed in children under 11 years. The newly proposed diagnostic criteria for MOGAD, developed by an international panel, 11 suggest the use of clinical syndrome, MOG-IgG serostatus, as well as the exclusion of alternative diagnoses such as MS and neuromyelitis optica spectrum disorder (NMOSD).…”

Section: Introductionmentioning

confidence: 99%

Susceptibility-based imaging aids accurate distinction of pediatric-onset MS from myelin oligodendrocyte glycoprotein antibody-associated disease

Sacco,

Virupakshaiah,

Papinutto

et al. 2023

Mult Scler

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Background: Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) and pediatric-onset multiple sclerosis (POMS) share clinical and magnetic resonance imaging (MRI) features but differ in prognosis and management. Early POMS diagnosis is essential to avoid disability accumulation. Central vein sign (CVS), paramagnetic rim lesions (PRLs), and central core lesions (CCLs) are susceptibility-based imaging (SbI)-related signs understudied in pediatric populations that may help discerning POMS from MOGAD. Methods: T2-FLAIR and SbI (three-dimensional echoplanar imaging (3D-EPI)/susceptibility-weighted imaging (SWI) or similar) were acquired on 1.5T/3T scanners. Two readers assessed CVS-positive rate (%CVS+), and their average score was used to build a receiver operator curve (ROC) assessing the ability to discriminate disease type. PRLs and CCLs were identified using a consensual approach. Results: The %CVS+ distinguished 26 POMS cases (mean age 13.7 years, 63% females, median EDSS 1.5) from 14 MOGAD cases (10.8 years, 35% females, EDSS 1.0) with ROC = 1, p < 0.0001, (cutoff 41%). PRLs were only detectable in POMS participants (mean 2.1±2.3, range 1–10), discriminating the two conditions with a sensitivity of 69% and a specificity of 100%. CCLs were more sensitive (81%) but less specific (71.43%). Conclusion: The %CVS+ and PRLs are highly specific markers of POMS. After proper validation on larger multicenter cohorts, consideration should be given to including such imaging markers for diagnosing POMS at disease onset.

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The State of the Art of Pediatric Multiple Sclerosis

Cited by 7 publications

References 124 publications

Pediatric Onset Multiple Sclerosis and Obesity: Defining the Silhouette of Disease Features in Overweight Patients

Pediatric Onset Multiple Sclerosis and Obesity: Defining the Silhouette of Disease Features in Overweight Patients

Infectious mononucleosis: new concepts in clinical presentation, epidemiology, and host response

Susceptibility-based imaging aids accurate distinction of pediatric-onset MS from myelin oligodendrocyte glycoprotein antibody-associated disease

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