Early predictors of disability in paediatric multiple sclerosis: evidence from a multi-national registry.
Journal: Journal of neurology, neurosurgery, and psychiatry
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Affiliated Institutions:
CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait.
Faculty of Medicine, Dokuz Eylul University, İzmir, Turkey.
Multiple Sclerosis Unit, Hospital Universitario Virgen Macarena, Sevilla, Spain.
Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic.
Department of Medical and Surgical Sciences and Advanced Technologies, Multiple Sclerosis Center, University of Catania, Catania, Italy.
Medical Faculty, Mayis University, Samsun, Turkey.
Department of Neurology, Karadeniz Technical University, Trabzon, Turkey.
Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon.
Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio, Chieti, Italy.
UOSI Riabilitazione Sclerosi Multipla, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
Department of Neurology, School of Medicine, Koc University, Istanbul, Turkey.
CHUM MS Center and Department of Neuroscience, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada.
Department of Neurology, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal.
Department of Neurology, AORN San Giuseppe Moscati, Avellino, Italy.
Department of Neurology, Razi Hospital, Manouba, Tunisia.
Clinical Investigation Center Neurosciences and Mental Health, Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia.
Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey.
Department of Neurology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
Department NEUROFARBA, University of Florence, Florence, Italy.
Department of Neurology, Universidade Metropolitana de Santos, Santos, Brazil.
CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia tomas.kalincik@unimelb.edu.au.
Abstract summary
Early recognition of markers of faster disability worsening in paediatric-onset multiple sclerosis (MS) is a key requisite of personalised therapy for children with MS at the earliest possible time.To identify early predictors of rapid disability accrual in patients with paediatric-onset MS.Using the global MSBase registry, we identified patients who were <18 years old at the onset of MS symptoms. The clinico-demographic characteristics examined as predictors of future MS Severity Score (MSSS) included sex, age at symptom onset, absence of disability at the initial assessment, maximum Expanded Disability Status Scale (EDSS) score, relapse frequency and presence of brainstem, pyramidal, visual or cerebellar symptoms in the first year. A Bayesian log-normal generalised linear mixed model adjusted for cumulative proportion of time on higher-efficacy disease-modifying therapies (DMTs) was used to analyse the data.672 patients (70% female) contributing 9357 visits were included. The median age at symptom onset was 16 (quartiles 15-17) years. Older age at symptom onset (exp(β)=1.10 (95% CI 1.04 to 1.17)), higher EDSS score (1.22 (1.12 to 1.34)) and pyramidal (1.31 (1.11 to 1.55)), visual (1.25 (1.10 to 1.44)) or cerebellar (1.18 (1.01 to 1.38)) symptoms in the first year were associated with higher MSSS. MSSS was reduced by 4% for every 24% increase in the proportion of time on higher-efficacy DMTs (0.96 (0.93 to 0.99)).A relatively later onset of MS in childhood, higher disability and pyramidal, visual or cerebellar symptoms during the first year predicted significant worsening in disability in patients with paediatric-onset MS. Persistent treatment with higher-efficacy DMTs was associated with a reduced rate of disability worsening.
Authors & Co-authors:
Sharmin Sifat S
Malpas Charles B CB
Roos Izanne I
Diouf Ibrahima I
Alroughani Raed R
Ozakbas Serkan S
Izquierdo Guillermo G
Eichau Sara S
Horakova Dana D
Havrdova Eva K EK
Patti Francesco F
Terzi Murat M
Boz Cavit C
Yamout Bassem B
Khoury Samia J SJ
Onofrj Marco M
Lugaresi Alessandra A
Altintas Ayse A
Prat Alexandre A
Girard Marc M
Duquette Pierre P
Sá Maria José MJ
La Spitaleri Daniele D
Sidhom Youssef Y
Gouider Riadh R
Mrabet Saloua S
Soysal Aysun A
Turkoglu Recai R
Amato Maria Pia MP
Fragoso Yara D YD
Kalincik Tomas T
Study Outcome
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