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Pediatric Multiple Sclerosis-Experience of a Tertiary Care Center
Cecília Martins1,2, Raquel Samões3,4, Ana Martins Silva3,4
1Department of Pediatrics, Centro Hospitalar do Médio Ave, V. N. Famalicão, Portugal.
Insights
Pediatric-onset multiple sclerosis (POMS) affects young patients, often leading to disability. Early diagnosis and treatment are vital for managing POMS and improving long-term outcomes in children and adolescents.
Area of Science:
- Neurology
- Pediatrics
- Immunology
Background:
- Pediatric-onset multiple sclerosis (POMS) constitutes 3-10% of all multiple sclerosis diagnoses.
- POMS is frequently characterized by high disease activity, increasing the risk of physical and cognitive impairment.
Purpose of the Study:
- To characterize a cohort of pediatric-onset multiple sclerosis patients treated at a Portuguese tertiary hospital.
- To analyze clinical manifestations, diagnostic timelines, and treatment strategies in POMS.
Main Methods:
- Retrospective observational study.
- Review of clinical records for POMS patients diagnosed between 2011 and 2020.
- Analysis of demographic data, clinical presentation, diagnostic markers, and treatment regimens.
Main Results:
- 21 patients (11 female:10 male) with a mean age of onset of 14.8 years were included.
- Common initial symptoms included myelitis (8 patients) and optic neuritis (6 patients).
- 19% of patients experienced cognitive deficits, and nearly half were on second-line disease-modifying therapies.
Conclusions:
- Early diagnosis is critical for improving outcomes in pediatric-onset multiple sclerosis.
- A significant proportion of POMS patients require second-line treatments and may experience cognitive impairment.
Background:
Pediatric-onset multiple sclerosis (POMS) accounts for 3 to 10% of all MS diagnoses. POMS is usually characterized by prominent disease activity, and patients are at higher risk of developing physical disability and cognitive impairment.
Objective:
This article characterizes a cohort of POMS patients followed at the pediatric neurology unit of a Portuguese tertiary hospital.
Methods:
Retrospective observational study. Clinical records of all patients with POMS between 2011 and 2020 were revised.
Results:
A total of 21 patients, with a female:male ratio of 11:10 and a mean age of onset of 14.8 years were included. Clinical manifestations at presentation included myelitis in eight patients (two with associated brainstem syndrome), optic neuritis in six (one with associated cerebellar syndrome), supratentorial symptoms in four, and isolated brainstem syndrome in two. Twenty patients had oligoclonal immunoglobulin G bands in cerebrospinal fluid. Supra- and infratentorial involvement was identified in the first brain magnetic resonance imaging of nine patients. Initial relapses were treated with intravenous steroids in 19 patients. The mean time for diagnosis was 2.8 months. Eleven patients were on first-line treatment (nine on β-interferon, two on teriflunomide) and 10 on second-line treatment (six on natalizumab, three on fingolimod, one on ocrelizumab). The mean annual relapse rate was 0.29 (range, 0.01-3), and the median Expanded Disability Status Scale was 1. Four patients reported learning disabilities and/or cognitive deficits.
Conclusion:
About half of patients in this cohort were on second-line disease-modifying treatment, with 19% showing cognitive impairment. Efforts to establish an early diagnosis are crucial to improving these patients' outcomes.
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