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Published on: June 30, 2014
Prognostic factors for early severity in a childhood multiple sclerosis cohort
Yann Mikaeloff1, Guillaume Caridade, Saada Assi
1Service de Neurologie Pédiatrique, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, INSERM U802, Paris, France. yann.mikaeloff@bct.aphp.fr
Insights
Researchers identified key factors predicting severe childhood-onset multiple sclerosis (MS). This helps identify at-risk children early for targeted interventions and future therapeutic studies.
Area of Science:
- Neurology
- Pediatrics
- Immunology
Background:
- Childhood-onset multiple sclerosis (MS) presents unique challenges in predicting disease course.
- Early identification of severe disease progression is crucial for timely intervention.
Purpose of the Study:
- To identify prognostic factors for an early severe course in pediatric multiple sclerosis.
- To develop a predictive tool for early identification of severe disease in children.
Main Methods:
- Analysis of a French cohort of 197 pediatric relapsing-remitting MS patients (onset < 16 years).
- Multivariate survival analysis (Cox model) assessed clinical, MRI, and biological factors at onset.
- Outcome defined as the occurrence of a third attack or severe disability.
Main Results:
- Severity risk increased in girls, with short intervals (<1 year) between the first two attacks, specific MRI criteria, absence of severe mental state changes, and progressive course.
- A predictive index showed over 35% positive predictive value for severity in the upper two quartiles.
Conclusions:
- Identified clinical and MRI factors form the basis of a predictive tool for early childhood-onset MS severity.
- This tool aims to identify high-risk subgroups, facilitating targeted therapeutic studies and improving patient management.
Objective:
The goal was to identify prognostic factors for an early severe course in a cohort of patients with childhood-onset multiple sclerosis, for the construction of a predictive tool.
Methods:
The cohort consisted of 197 children from the French Kid Sclérose en Plaques neuropediatric cohort with relapsing/remitting multiple sclerosis beginning before the age of 16 years. Patients were included from 1990 to 2003. We used multivariate survival analysis (Cox model) to evaluate the prognostic value of clinical, MRI, and biological covariates at onset for the occurrence of a third attack or severe disability ("severity" outcome).
Results:
The cohort was monitored for a mean of 5.5 +/- 3.6 years. The "severity" outcome was recorded for 144 patients (73%). The risk of severity was higher for girls, for a time between the first and second attacks of < 1 year, for childhood-onset multiple sclerosis MRI criteria at onset, for an absence of severe mental state changes at onset, and for a progressive course. A derived childhood-onset multiple sclerosis potential index for early severity was found to have a positive predictive value for severity of > 35% for the upper 2 quartiles.
Conclusions:
The clinical and MRI prognostic factors for early severity that were identified were used as the basis of a predictive tool, which will be validated in another cohort. This tool should make it possible to identify subgroups at risk of early severe disease and should facilitate therapeutic studies.
