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Prospective study of multiple sclerosis with early onset.
A Ghezzi1, C Pozzilli, M Liguori
1Centro Studi Sclerosi Multipla, Ospedale di Gallarate, Universìta di Milano, Milan, Italy. centro.sm@libero.it
Multiple Sclerosis (Houndmills, Basingstoke, England)
|May 7, 2002
Summary
Pediatric multiple sclerosis (MS) onset in females may be linked to hormonal changes. Early disability and relapses in the first two years predict long-term MS progression.
Area of Science:
- Neurology
- Immunology
Background:
- Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system.
- Early-onset MS, particularly in pediatric populations, presents unique challenges in understanding disease trajectory and long-term outcomes.
- Hormonal influences, especially in females, are increasingly investigated for their role in MS pathogenesis.
Purpose of the Study:
- To investigate the clinical characteristics and long-term prognosis of multiple sclerosis (MS) with onset before age 15.
- To explore potential correlations between early disease indicators and subsequent disability progression.
- To examine gender differences and potential hormonal influences on MS onset and course.
Main Methods:
- Prospective study of 54 subjects with clinically definite MS diagnosed before age 15 across five Italian centers.
- Longitudinal follow-up averaging 10.9 years, assessing functional systems, onset symptoms, disease course, and disability using the Expanded Disability Status Scale (EDSS).
- Statistical analysis to identify predictors of long-term disability and prognosis, including early disability and relapse rates.
Main Results:
- The study included 36 females and 18 males, with a higher female-to-male ratio observed in older age groups, suggesting hormonal influences.
- Pyramidal and brainstem systems were most frequently involved at onset (28% each). The majority of cases (57%) had monosymptomatic onset.
- The relapsing-remitting course was most common (72%). After 8 years, 68% of patients had an EDSS score below 4. Early disability (first year) was a strong predictor of later disability (p=0.008).
Conclusions:
- Early disability and the number of relapses within the first two years are significant predictors of long-term disability in pediatric-onset MS.
- While age and gender did not influence the outcome, the female predominance suggests a potential role for hormonal factors in MS onset.
- This study highlights the importance of early assessment and monitoring for predicting the long-term course of pediatric multiple sclerosis.