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Age-Onset-Related Particularities of Pediatric MS-Understanding the Spectrum: A Tertiary Center Experience
Alice Denisa Dică1,2, Dana Craiu1,2, Florentina Ionela Linca3,4
1Pediatric Neurology Department, Prof. Dr. Alex. Obregia Clinical Hospital of Psychiatry, 041914 Bucharest, Romania.
Insights
Pediatric multiple sclerosis (MS) varies by age at onset. Early-onset MS (<10 years) shows atypical symptoms and more relapses, highlighting the need for prompt, high-efficacy treatments to improve outcomes.
Area of Science:
- Neurology
- Pediatric Neurology
- Neuroimmunology
Background:
- Pediatric-onset multiple sclerosis (POMS) is a rare, heterogeneous neurological condition.
- Clinical features, disease progression, and treatment responses in POMS significantly differ based on the patient's age at onset.
- Early-onset MS (under 10 years) presents unique diagnostic and management challenges due to atypical symptoms and heightened inflammatory activity.
Purpose of the Study:
- To investigate age-related clinical, radiological, and therapeutic characteristics of pediatric MS.
- To specifically analyze early-onset cases (<10 years) and compare them with intermediate (10-12 years) and late-onset (>12 years) forms of the disease.
Main Methods:
- Retrospective analysis of medical records from 120 pediatric patients with MS diagnosed between 2018 and 2024.
- Patients were stratified by age at onset: early (<10 years), intermediate (10-12 years), and late (>12 years).
- Assessment included clinical presentation, relapse frequency and timing, Expanded Disability Status Scale (EDSS) scores, MRI findings, and treatment patterns.
Main Results:
- Early-onset MS is linked to atypical symptoms, delayed diagnosis, increased relapse rates, and multifocal brainstem/cerebellar lesions.
- Diagnosis was significantly delayed in younger children compared to adolescents.
- While EDSS scores remained stable initially, early-onset patients experienced a decline after year four. High-efficacy therapies were underutilized due to age restrictions.
- Intermediate-onset patients showed mixed features and the best motor function preservation (EDSS 0) at follow-up.
- Younger patients exhibited more extensive and confluent MRI lesions, particularly within the first two years post-onset.
Conclusions:
- Age at onset is a critical factor influencing the clinical trajectory and treatment efficacy in pediatric MS.
- Early identification and prompt initiation of appropriate therapies, including high-efficacy agents, are crucial for mitigating long-term disability.
- Further multicenter research with standardized protocols for imaging and cognitive assessments is essential to refine care strategies for pediatric MS patients.
Background:
Pediatric-onset multiple sclerosis (POMS) is a rare and heterogeneous condition, with clinical features, progression, and therapeutic response varying significantly according to age at onset. Early-onset MS (<10 years) presents particular diagnostic and management challenges due to atypical presentations and more active inflammatory profiles.
Objectives:
To identify age-related clinical, radiological, and therapeutic characteristics of pediatric MS, with a specific focus on early-onset cases, and to compare them with intermediate (10-12 years) and late-onset (>12 years) forms.
Methods:
We conducted a retrospective analysis of medical records from 120 pediatric patients diagnosed with MS at a tertiary neurology center between 2018 and 2024. Patients were grouped by age at onset and assessed for clinical presentation, number and timing of relapses, EDSS scores, imaging findings, and treatment patterns.
Results:
Early-onset MS was associated with atypical symptoms, delayed diagnosis, more frequent relapses, and multifocal brainstem and cerebellar involvement. The diagnosis was significantly delayed in younger children compared to adolescents. EDSS scores tended to remain stable in the first 2-3 years, but early-onset patients showed a notable decline after the fourth year. While most patients received disease-modifying therapies, high-efficacy agents were underused due to age-related restrictions. Intermediate-onset patients presented overlapping features of both early and late-onset MS and had the highest proportion of fully preserved motor function (EDSS 0) at the end of follow-up. MRI findings revealed more extensive and confluent lesions in younger patients, particularly in the first two years after onset.
Conclusions:
Age at disease onset is a key determinant of clinical course and treatment response in pediatric MS. Early recognition and timely initiation of appropriate therapy-especially high-efficacy agents-may improve outcomes and reduce long-term disability. Further multicenter studies with standardized imaging and cognitive assessment protocols are needed to optimize care for this vulnerable population.
