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School performance in a cohort of children with CNS inflammatory demyelination
Yann Mikaeloff1, Guillaume Caridade, Catherine Billard
1Assistance Publique-Hôpitaux de Paris, Service de Neurologie Pédiatrique and Centre de Référence National des Maladies Inflammatoires du cerveau de l'Enfant, Hôpital Bicêtre, Université Paris Sud 11, Le Kremlin Bicêtre, France. yann.mikaeloff@bct.aphp.fr
Insights
Children experiencing acute central nervous system inflammatory demyelination face risks to school performance. Factors like low socioeconomic status and severe disease onset predict poorer academic outcomes.
Area of Science:
- Pediatric Neurology
- Neuroimmunology
- Epidemiology
Background:
- Childhood acute central nervous system (CNS) inflammatory demyelination can cause lasting cognitive deficits.
- No prior studies assessed school performance predictors in pediatric demyelinating disease cohorts.
Purpose of the Study:
- To identify prognostic factors for school performance in children with acute CNS inflammatory demyelination.
- To evaluate the impact of socioeconomic status and disease characteristics on academic outcomes.
Main Methods:
- A cohort of 344 children diagnosed before age 16 with CNS inflammatory demyelination was analyzed.
- Multivariate survival analysis (Cox model) assessed grade retention predictors over a mean 8.0-year follow-up.
Main Results:
- 43.9% of patients experienced grade retention post-disease onset.
- Higher risk of grade retention was associated with male sex, lower socioeconomic status, poorer housing, older age at onset (>11 years), and optic neuritis or brainstem dysfunction.
Conclusions:
- Poor school performance in pediatric CNS inflammatory demyelination is linked to socioeconomic factors.
- Disease characteristics predicting a severe, relapsing course, potentially leading to multiple sclerosis, also indicate higher risk for academic difficulties.
Background:
Acute CNS inflammatory demyelination in childhood may induce permanent cognitive impairment. However, there has been no epidemiological assessment of prognostic factors for school performance in a cohort of children with such a disease.
Methods:
The cohort consisted of 344 children from the French "KIDSEP" neuropediatric cohort with at least one clinically defined attack of CNS inflammatory demyelination occurring before the age of 16 years, and with at least two years of follow-up (inclusion from 1990 to 2003, follow-up until June 2007). We used multivariate survival analysis (Cox model) to evaluate the prognostic value for grade retention between the start of elementary school ( approximately 6 years of age) and the end of high school ( approximately 17-18 years of age), of variables related to both the socioeconomic status of the parents and the characteristics of the disease at onset.
Results:
The cohort was monitored for a mean of 8.0+/-3.4 years. Grade retention after disease onset was recorded for 151 patients (43.9%). The risk of grade retention was significantly higher for boys, children from families with lower social status and poorer housing conditions, children over the age of 11 years at disease onset and children suffering optic neuritis or brainstem dysfunction at the first attack or irreversible disability, even if only moderate, following the first attack.
Conclusions:
The risk factors for poor school performance are related to low socioeconomic status and to factors predictive of a relapsing severe course of the disease, leading to the diagnosis of multiple sclerosis.
