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Characterization of children with early onset pediatric multiple sclerosis
Franziska Kauth1, Annikki Bertolini1, Eva-Maria Wendel2
1Department of Pediatric Neurology, Children's Hospital Datteln, Witten/Herdecke University, Datteln, Germany.
Insights
Early onset pediatric multiple sclerosis (EOPMS) shows more relapses and infratentorial lesions compared to late onset pediatric MS (LOPMS). EBV infection may not be essential for EOPMS development.
Area of Science:
- Neurology
- Pediatrics
- Immunology
Background:
- Early onset pediatric multiple sclerosis (EOPMS) offers a crucial window into MS pathogenesis.
- Understanding differences between EOPMS and late onset pediatric MS (LOPMS) is vital for targeted interventions.
Purpose of the Study:
- To compare clinical, laboratory, and imaging characteristics of EOPMS (<11 years) versus LOPMS (≥11 years).
Main Methods:
- Analysis of prospectively collected data from 274 pediatric MS patients.
- Inclusion criteria: clinical presentation, MRI, relapse data, treatment history, and CSF markers.
Main Results:
- EOPMS (n=53) and LOPMS (n=221) showed sex distribution differences (equal in EOPMS, female-predominant in LOPMS).
- Cerebrospinal fluid (CSF) oligoclonal bands (OCBs) were similar (approx. 90%).
- EOPMS patients had more relapses in the first 2 years and LOPMS patients had more spinal lesions.
Conclusions:
- EOPMS and LOPMS share similarities but differ in relapse rates and lesion locations (infratentorial in EOPMS).
- Epstein-Barr virus (EBV) infection may not be a prerequisite for EOPMS development.
Background:
Early onset pediatric multiple sclerosis (EOPMS) provides an early window of opportunity to understand the mechanisms leading to MS.
Objective:
To investigate clinical, laboratory and imaging differences between children with early onset pediatric MS (<11 years, EOPMS) and late onset pediatric MS (≥11 years, LOPMS).
Methods:
Mostly prospectively collected data of children with MS including clinical presentation, MRI at onset, time to second relapse, relapse rate, treatment history, and CSF markers were eligible.
Results:
In total 274 children were included, n = 53 children with EOPMS and n = 221 children with LOPMS. In children with EOPMS both sexes were equally affected, while in LOPMS the female sex was more prevalent (p < 0.001). Presence of additional oligoclonal bands (OCBs) in the cerebrospinal fluid (CSF) was comparable in both age groups (92.3 % vs 89.5 %). Children with EOPMS had more relapses in the first 2 years (p = 0.004). Children with LOPMS had significantly more spinal lesions (p = 0.001). Presence of a prior EBV infection tested in a subset of children with EOPMS (n = 34) was only detected in 27/34 (79 %).
Conclusion:
Our findings suggest that both groups share important similarities but also important differences such as an increased relapse rate and a higher amount of infratentorial lesions in EOPMS. Furthermore, our results allude to a prior EBV-infection possibly not being an indispensable requirement for the development of MS in children with EOPMS.
