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Prognostic indicators in pediatric clinically isolated syndrome

Pietro Iaffaldano1, Marta Simone2, Giuseppe Lucisano1,3

  • 1Department of Basic Medical Sciences, Neurosciences, and Sense Organs, University of Bari Aldo Moro, Bari, Italy.

Annals of Neurology
|April 26, 2017
PubMed

Insights

Female sex and multifocal onset predict a second attack in pediatric clinically isolated syndrome (pCIS). Early disease-modifying drug (DMD) treatment reduces risk for both attacks and disability progression in pediatric multiple sclerosis (MS).

Area of Science:

  • Neurology
  • Pediatric Neurology
  • Neuroimmunology

Background:

  • Pediatric clinically isolated syndrome (pCIS) is the initial presentation suggestive of multiple sclerosis (MS) in children.
  • Identifying prognostic factors is crucial for early intervention and management of pediatric MS (POMS).

Purpose of the Study:

  • To determine predictors of a second clinical attack and the first disability-worsening event in pediatric patients with CIS.
  • To evaluate the impact of disease-modifying drug (DMD) treatment on disease course.

Main Methods:

  • A cohort of 770 pediatric CIS patients was followed for over 10 years.
  • Cox proportional hazard models and Recursive Partitioning and Amalgamation (RECPAM) were employed for data analysis.
  • Analysis focused on identifying risk factors for clinical attacks and disability progression (Expanded Disability Status Scale - EDSS).

Main Results:

  • In pCIS, female sex and multifocal onset were associated with an increased risk of a second clinical attack, while DMD exposure showed a protective effect.
  • After POMS diagnosis, younger age at onset (<15 years) and DMD exposure reduced the risk of a first EDSS-worsening event.
  • Relapse occurrence significantly increased the risk of EDSS worsening, and DMD exposure was confirmed as the most protective factor.

Conclusions:

  • This study identifies key predictors of disease course in pediatric CIS and POMS.
  • Early initiation of DMD treatment demonstrates a protective effect against MS development and disability accumulation in this pediatric population.
Abstract

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