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Healthcare use before paediatric multiple sclerosis onset differs by age and sex: a nationwide cohort study

Fredrik Sandesjö1,2, Kyla McKay3,4, Ali Manouchehrinia3

  • 1Neuropaediatric Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.

BMJ Neurology Open
|January 1, 2026
PubMed

Insights

Healthcare use before paediatric-onset multiple sclerosis (MS) differs by age and sex. Males showed increased skin-related visits, while females had more neoplasm visits, indicating potential early MS detection markers.

Area of Science:

  • Neurology
  • Paediatric Medicine
  • Epidemiology

Background:

  • Healthcare utilization preceding clinical onset suggests a prodromal phase for multiple sclerosis (MS).
  • Data on the prodromal phase of paediatric-onset MS (PoMS) are limited, particularly concerning age- and sex-specific patterns.
  • Understanding these patterns is crucial for early PoMS detection and research into MS mechanisms.

Purpose of the Study:

  • To investigate age- and sex-specific healthcare utilization patterns in the years leading up to clinical onset of PoMS.
  • To identify potential early indicators of PoMS through analysis of healthcare visits and prescriptions.

Main Methods:

  • Utilized the Swedish MS registry to identify individuals with MS onset before age 18.
  • Compared healthcare utilization (hospitalizations, outpatient visits, prescriptions) for 233 PoMS cases against 1151 matched controls up to 16 years pre-onset.
  • Analyzed data stratified by age at onset (12-15 and 16-17 years) and sex.

Main Results:

  • Females with PoMS had higher rates of outpatient visits for neoplasms (RR 3.44-5.73) preceding onset.
  • Males with PoMS showed increased rates of skin-related visits (RR 6.00-11.00) and dermatological corticosteroid prescriptions (RR 3.12).
  • Older teenagers (16-17 years) had higher neoplasm-related visit rates, while younger teenagers (12-15 years) had higher nervous system-related visit rates.

Conclusions:

  • PoMS is associated with distinct age- and sex-specific healthcare utilization patterns before clinical symptom onset.
  • Findings highlight increased skin-related visits in males and neoplasm-related visits in females and older adolescents as potential early signs.
  • These insights can inform earlier detection strategies for PoMS and advance understanding of MS pathogenesis.
Abstract

Keywords:
EPIDEMIOLOGYMULTIPLE SCLEROSISPAEDIATRIC

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