Related Experiment Videos
Prognostic indicators of secondary progression in a paediatric-onset multiple sclerosis cohort in Kuwait
Saeed Akhtar1, Raed Alroughani2, Samar F Ahmed3
1Department of Community Medicine and Behavioural Sciences, University of Kuwait, Kuwait saeed.akhtar@hsc.edu.kw.
Insights
Paediatric-onset multiple sclerosis (POMS) in the Middle East is more common than previously thought. Brainstem involvement and older age at onset increase the risk of secondary progressive multiple sclerosis (SPMS) in these young patients.
Area of Science:
- Neurology
- Epidemiology
- Clinical Research
Background:
- Paediatric-onset multiple sclerosis (POMS) and its secondary progression risk are understudied in the Middle East.
- This study addresses the knowledge gap regarding POMS frequency and SPMS risk in the region.
Purpose of the Study:
- To determine the frequency of POMS in the Middle East.
- To identify prognostic factors for the development of secondary progressive multiple sclerosis (SPMS) in POMS patients.
Main Methods:
- A cross-sectional cohort study utilizing the Kuwait National MS Registry (1994-2013).
- Identified 127 POMS cases (diagnosed <18 years) from 808 MS patients.
- Employed a multivariable Cox proportional hazards model to analyze prognostic factors.
Main Results:
- POMS accounted for 15.7% of MS cases, with a median onset age of 16.0 years.
- 15.8% of POMS patients progressed to SPMS.
- Brainstem involvement (aHR 5.71) and older age at onset (aHR 1.38) significantly predicted SPMS development.
Conclusions:
- POMS patients with brainstem/cerebellar involvement and higher age at onset are predisposed to SPMS.
- These findings suggest a need for aggressive therapeutic strategies in high-risk POMS individuals.
Background:
The frequency of paediatric-onset multiple sclerosis (POMS) and the precise risk of secondary progression of disease are largely unknown in the Middle East. This cross-sectional cohort study assessed the risk and examined prognostic factors for time to onset of secondary progressive multiple sclerosis (SPMS) in a cohort of POMS patients.
Methods:
The Kuwait National MS Registry database was used to identify a cohort of POMS cases (diagnosed at age <18 years) from 1994 to 2013. Data were abstracted from patients' records. A Cox proportional hazards model was used to evaluate the prognostic significance of the variables considered.
Results:
Of 808 multiple sclerosis (MS) patients, 127 (15.7%) were POMS cases. The median age (years) at disease onset was 16.0 (range 6.5-17.9). Of 127 POMS cases, 20 (15.8%) developed SPMS. A multivariable Cox proportional hazards model showed that at MS onset, brainstem involvement (adjusted hazard ratio 5.71; 95% confidence interval 1.53-21.30; P=0.010), and POMS patient age at MS onset (adjusted hazard ratio 1.38; 95% confidence interval 1.01-1.88; P=0.042) were significantly associated with the increased risk of a secondary progressive disease course.
Conclusions:
This study showed that POMS patients with brainstem/cerebellar presentation and a relatively higher age at MS onset had disposition for SPMS and warrant an aggressive therapeutic approach.