1
|
Alkolfat F, Said S, Mekky J, Eldeeb H. What an adult multiple sclerosis registry can tell us about pediatric onset multiple sclerosis? Mult Scler Relat Disord 2023; 79:104962. [PMID: 37714097 DOI: 10.1016/j.msard.2023.104962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/05/2023] [Accepted: 08/28/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Multiple Sclerosis (MS) is an immune-mediated, chronic disease of the central nervous system that affects mainly adults. However, it is increasingly recognized that MS may start in childhood resulting in a relentlessly progressive disability and cognitive impairment. Registries across the globe are reporting inconstant data about their Pediatric-Onset Multiple Sclerosis (POMS) patients. Moreover, newer lines of treatments are emerging and showing efficacy in controlling the MS disease regardless of the onset. Therefore, there is a requirement for more research into the clinical profile of POMS in different populations and ethnicities. METHODS This study was a cross-sectional study that included MS patients who visited the MS unit at Alexandria University from January 2019 to January 2021. We analyzed their epidemiological, clinical, radiological data, and cerebrospinal fluid (CSF) results from their updated records as well as follow-up interviews. RESULTS Annual Relapse Rate (ARR) was marginally less in POMS than AOMS (0.72 ± 0.57 vs 1.04 ± 0.78 relapse/year, P =.008). POMS patients had a bigger gap to their first relapse (40.0 ± 47.35 vs 22.71 ± 34.33 months, p= .066). The difference in relapse rate between the two groups was abolished after the exclusion of patients who had a gap of more than 5 years to their first relapse. AOMS patients were significantly more likely to start with a second-line disease-modifying treatment (DMT) than POMS patients (11.5% vs 31%, p= .04), whereas POMS patients were more likely to be escalated to the second line (34.6% vs 19.3%, p= .07). ARR had a positive and significant correlation with expanded disability status scale (EDSS) progression per year (rs(24)= .57 p=.003). A Mann-Whitney test indicated that POMS patients who had infratentorial involvement in the initial MRI brain had higher EDSS (3.08 ± 1.99) than POMS who did not (1.07 ± 0.79) U=24 P =.013. IgG index had a significant and positive correlation with annual EDSS progression rate rs (8) = 0.8 p=.001. CONCLUSION Early disease onset does not mean a higher relapse rate when including the full spectrum of POMS and longer follow-up duration. POMS patients relapsed more on the first-line DMT and escalation should be considered early. Infratentorial involvement in the initial magnetic resonance imaging (MRI) brain and high IgG index are potential predictors for aggressive disease course in POMS.
Collapse
Affiliation(s)
- Fatma Alkolfat
- Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Sameh Said
- Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Jaidaa Mekky
- Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hany Eldeeb
- Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| |
Collapse
|
2
|
Mandato C, Colucci A, Lanzillo R, Staiano A, Scarpato E, Schiavo L, Operto FF, Serra MR, Di Monaco C, Napoli JS, Massa G, Vajro P. Multiple Sclerosis-Related Dietary and Nutritional Issues: An Updated Scoping Review with a Focus on Pediatrics. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1022. [PMID: 37371254 DOI: 10.3390/children10061022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/03/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE Lifestyle/dietetic habits play an important role in the development and progression of multiple sclerosis (MS) disease. Here, we examine the basic pathomechanisms underlying intestinal and brain barrier modifications in MS and consider diets and dietary supplementations proposed over time to complement pharmacological therapies for improving disease outcome both in adults and in children. METHODS Scoping literature search about evidence-based findings in MS-related gut-brain axis (GBA) pathophysiology and nutritional issues at all ages. FINDINGS Data show that (1) no universal best diet exists, (2) healthy/balanced diets are, however, necessary to safeguard the adequate intake of all essential nutrients, (3) diets with high intakes of fruits, vegetables, whole grains, and lean proteins that limit processed foods, sugar, and saturated fat appear beneficial for their antioxidant and anti-inflammatory properties and their ability to shape a gut microbiota that respects the gut and brain barriers, (4) obesity may trigger MS onset and/or its less favorable course, especially in pediatric-onset MS. Vitamin D and polyunsaturated fatty acids are the most studied supplements for reducing MS-associated inflammation. CONCLUSIONS Pending results from other and/or newer approaches targeting the GBA (e.g., pre- and probiotics, engineered probiotics, fecal-microbiota transplantation), accurate counseling in choosing adequate diet and maintaining physical activity remains recommended for MS prevention and management both in adults and children.
Collapse
Affiliation(s)
- Claudia Mandato
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Pediatrics Section, University of Salerno, 84081 Baronissi, Salerno, Italy
| | - Angelo Colucci
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Pediatrics Section, University of Salerno, 84081 Baronissi, Salerno, Italy
| | - Roberta Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, 80138 Naples, Naples, Italy
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, 80138 Naples, Naples, Italy
| | - Elena Scarpato
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, 80138 Naples, Naples, Italy
| | - Luigi Schiavo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Nutrition Section, University of Salerno, 84081 Baronissi, Salerno, Italy
| | - Francesca Felicia Operto
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Pediatric Psychiatry Section, University of Salerno, 84081 Baronissi, Salerno, Italy
| | - Maria Rosaria Serra
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, 80138 Naples, Naples, Italy
| | - Cristina Di Monaco
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, 80138 Naples, Naples, Italy
| | - Julia Sara Napoli
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Pediatrics Section, University of Salerno, 84081 Baronissi, Salerno, Italy
| | - Grazia Massa
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Pediatrics Section, University of Salerno, 84081 Baronissi, Salerno, Italy
| | - Pietro Vajro
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Pediatrics Section, University of Salerno, 84081 Baronissi, Salerno, Italy
| |
Collapse
|
3
|
Brola W, Steinborn B, Żak M, Mazurkiewicz-Bełdzińska M, Jóźwiak S, Sobolewski P, Wilski M, Bilska M, Siedlarska M, Puzio-Bochen I, Wencel-Warot A, Lemka M, Kroczka S, Czyżyk E, Bocheńska M, Emich-Widera E, Pietruszewski J, Boćkowski L, Kapica-Topczewska K, Czarnowska A, Kułakowska A, Ujma-Czapska B, Gruna-Ożarowska A, Przysło Ł, Połatyńska K, Dudzińska M, Mitosek-Szewczyk K, Melnyk A, Adamczyk-Sowa M, Kotulska K. The Clinical and Epidemiological Profile of Paediatric-Onset Multiple Sclerosis in Poland. J Clin Med 2022; 11:jcm11247494. [PMID: 36556109 PMCID: PMC9785459 DOI: 10.3390/jcm11247494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/11/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Background. Paediatric-onset MS (POMS) has a unique clinical profile compared to the more prevalent adult-onset MS. For this study, we aimed to determine the demographic and clinical characteristics of POMS in Poland as well as addressing some of its epidemiological aspects. Methods. A retrospective study was conducted based on the Polish Multiple Sclerosis Registry, considering a population of children and adolescents with MS (age ≤ 18 years). Data were collected by all 13 centres across Poland specializing in diagnosing and treating POMS. The actual course of the disease and its clinical properties were compared between child (≤12 years) and juvenile (>12 years) patients. MS onset and its prevalence were assessed at the end of 2019, stratified by age range. Results. A total of 329 paediatric or juvenile patients (228 girls, 101 boys) with a clinically definite diagnosis of MS, in conformity with the 2017 McDonald Criteria, were enrolled. For 71 children (21.6%), the first symptoms appeared before the age of 12. The female: male ratio increased with age, amounting to 1:1 in the ≤12 years group and to 2.9:1 in the >12 years group. In most cases, the disease had multi-symptomatic onset (31.3%), and its course was mostly of a relapsing−remitting character (95.7%). The initial Expanded Disability Status Score for both groups was 1.63 ± 1.1, whereas the annual relapse rate was 0.84 during the first 2 years. The time between the onset of symptoms and diagnosis was longer in the younger patients (8.2 ± 4.2 vs. 4.6 ± 3.6 months; p < 0.005). On 31 December 2019, the age-adjusted prevalence standardized to the European standard population was 5.19/100,000 (95% CI, 4.64−5.78). Significantly higher prevalence was noted in the 13−18 years group (7.12; 95% CI, 6.64−7.86) than in the 9−12 years group (3.41; 95% CI, 2.98−3.86) and the <9 years group (0.56; 95% CI, 0.46−0.64; p < 0.001). Conclusion. POMS commencing at the age of ≤12 years is rare, differing significantly from the juvenile-onset and adult MS in terms of clinical characteristics, course, and incidence, as stratified by gender.
Collapse
Affiliation(s)
- Waldemar Brola
- Collegium Medicum, Jan Kochanowski University, 25-369 Kielce, Poland
- Correspondence: ; Tel.: +48-601313415
| | - Barbara Steinborn
- Department of Developmental Neurology, Poznan University of Medical Sciences, 61-545 Poznań, Poland
| | - Marek Żak
- Collegium Medicum, Jan Kochanowski University, 25-369 Kielce, Poland
| | | | - Sergiusz Jóźwiak
- Department of Child Neurology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Piotr Sobolewski
- Collegium Medicum, Jan Kochanowski University, 25-369 Kielce, Poland
| | - Maciej Wilski
- Department of Adapted Physical Activity, Poznań University of Physical Education, 61-871 Poznań, Poland
| | - Małgorzata Bilska
- Department of Child Neurology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Magdalena Siedlarska
- Department of Child Neurology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Iwona Puzio-Bochen
- Department of Neurology and Epileptology, The Children’s Memorial Health Institute, 04-783 Warsaw, Poland
| | - Agnieszka Wencel-Warot
- Department of Developmental Neurology, Poznan University of Medical Sciences, 61-545 Poznań, Poland
| | - Małgorzata Lemka
- Department of Developmental Neurology, Medical University of Gdańsk, 80-952 Gdańsk, Poland
| | - Sławomir Kroczka
- Department of Child and Adolescent Neurology, Medical College, Jagiellonian University in Kraków, 30-663 Kraków, Poland
| | - Elżbieta Czyżyk
- Clinical Department of Child Neurology, Clinical Central Hospital No 2 in Rzeszow, 35-301 Rzeszów, Poland
| | - Małgorzata Bocheńska
- Clinical Department of Child Neurology, Clinical Central Hospital No 2 in Rzeszow, 35-301 Rzeszów, Poland
| | - Ewa Emich-Widera
- Department of Pediatric Neurology, School of Medicine in Katowice, Medical University of Silesia Katowice, 41-808 Katowice, Poland
| | - Jerzy Pietruszewski
- Department of Pediatric Neurology, School of Medicine in Katowice, Medical University of Silesia Katowice, 41-808 Katowice, Poland
| | - Leszek Boćkowski
- Department of Pediatric Neurology and Rehabilitation, Medical University of Białystok, 15-274 Białystok, Poland
| | | | - Agata Czarnowska
- Department of Neurology, Medical University of Białystok, 15-276 Bialystok, Poland
| | - Alina Kułakowska
- Department of Neurology, Medical University of Białystok, 15-276 Bialystok, Poland
| | - Barbara Ujma-Czapska
- Department of Social Pediatrics, Faculty of Health Sciences, Wrocław Medical University, 51-618 Wrocław, Poland
| | - Agata Gruna-Ożarowska
- Department of Social Pediatrics, Faculty of Health Sciences, Wrocław Medical University, 51-618 Wrocław, Poland
| | - Łukasz Przysło
- Department of Developmental Neurology, Polish Mother’s Memorial Hospital Research Institute, 93-338 Łódź, Poland
| | - Katarzyna Połatyńska
- Department of Developmental Neurology, Polish Mother’s Memorial Hospital Research Institute, 93-338 Łódź, Poland
| | - Magdalena Dudzińska
- Children’s Neurology Ward, Dr. E. Hanke Centre of Pediatrics and Oncology of Chorzów, 41-500 Chorzów, Poland
| | | | - Aleksandra Melnyk
- Department of Child Neurology, Regional Specialized Children’s Hospital, Olsztyn, Poland, and Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-082 Olsztyn, Poland
| | - Monika Adamczyk-Sowa
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 40-055 Katowice, Poland
| | - Katarzyna Kotulska
- Department of Neurology and Epileptology, The Children’s Memorial Health Institute, 04-783 Warsaw, Poland
| |
Collapse
|
4
|
Immovilli P, De Mitri P, Bazzurri V, Vollaro S, Morelli N, Biasucci G, Magnifico F, Marchesi E, Lombardelli ML, Gelati L, Guidetti D. The Impact of Highly Effective Treatment in Pediatric-Onset Multiple Sclerosis: A Case Series. CHILDREN 2022; 9:children9111698. [PMID: 36360426 PMCID: PMC9688929 DOI: 10.3390/children9111698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/24/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Abstract
Introduction: Pediatric-onset multiple sclerosis (POMS) is characterized by high inflammatory disease activity. Our aim was to describe the treatment sequencing and report the impact highly effective disease-modifying treatment (HET) had on disease activity. Materials and Methods: Five consecutive patients with POMS were administered HET following lower efficacy drug or as initial therapy. Data on treatment sequencing, relapses and MRIs were collected during the follow-up. Results: Our patients had an average age of 13.8 years (range 9–17) at diagnosis and 13.4 years (range 9–16) at disease onset, and 2/5 (40%) POMS were female. The pre-treatment average annualized relapse rate was 1.6 (range 0.8–2.8), and the average follow-up length was 5 years (range 3–7). A total of 2/5 (40%) patients were stable on HET at initial therapy, and 3/5 (60%) required an escalation to more aggressive treatment, even if two of them had been put on HET as initial treatment. Four out of five patients (80%) had No Evidence of Disease Activity-3 status (NEDA-3) at an average follow-up of 3 years (range 2–5). Conclusion: It has been observed that in a recent time period all the cases had prompt diagnosis, early HET or escalation to HET with a good outcome in 80% of the cases.
Collapse
Affiliation(s)
- Paolo Immovilli
- The Neurology Unit, Emergency Department, Guglielmo da Saliceto Hospital, Via Taverna 39, 29121 Piacenza, Italy
- Correspondence: ; Tel.: +39-0523-302408
| | - Paola De Mitri
- The Neurology Unit, Emergency Department, Guglielmo da Saliceto Hospital, Via Taverna 39, 29121 Piacenza, Italy
| | - Veronica Bazzurri
- The Neurology Unit, Emergency Department, Guglielmo da Saliceto Hospital, Via Taverna 39, 29121 Piacenza, Italy
| | - Stefano Vollaro
- The Neurology Unit, Emergency Department, Guglielmo da Saliceto Hospital, Via Taverna 39, 29121 Piacenza, Italy
| | - Nicola Morelli
- The Neurology Unit, Emergency Department, Guglielmo da Saliceto Hospital, Via Taverna 39, 29121 Piacenza, Italy
| | - Giacomo Biasucci
- The Pediatric Unit, Maternal and Child Department, Guglielmo da Saliceto Hospital, Via Taverna 39, 29121 Piacenza, Italy
| | - Fabiola Magnifico
- The Neurology Unit, Emergency Department, Guglielmo da Saliceto Hospital, Via Taverna 39, 29121 Piacenza, Italy
| | - Elena Marchesi
- The Neurology Unit, Emergency Department, Guglielmo da Saliceto Hospital, Via Taverna 39, 29121 Piacenza, Italy
| | - Maria Lara Lombardelli
- The Neurology Unit, Emergency Department, Guglielmo da Saliceto Hospital, Via Taverna 39, 29121 Piacenza, Italy
| | - Lorenza Gelati
- The Neurology Unit, Emergency Department, Guglielmo da Saliceto Hospital, Via Taverna 39, 29121 Piacenza, Italy
| | - Donata Guidetti
- The Neurology Unit, Emergency Department, Guglielmo da Saliceto Hospital, Via Taverna 39, 29121 Piacenza, Italy
| |
Collapse
|
5
|
Szewczyk AK, Papuć E, Mitosek-Szewczyk K, Woś M, Rejdak K. NMOSD-Diagnostic Dilemmas Leading towards Final Diagnosis. Brain Sci 2022; 12:885. [PMID: 35884693 PMCID: PMC9313254 DOI: 10.3390/brainsci12070885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/31/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: The emergence of white matter lesions in the central nervous system (CNS) can lead to diagnostic dilemmas. They are a common radiological symptom and their patterns may overlap CNS or systemic diseases and provoke underdiagnosis or misdiagnosis. The aim of the study was to assess factors influencing the underdiagnosis of neuromyelitis optica spectrum disorder (NMOSD) as well as to estimate NMOSD epidemiology in Lubelskie voivodeship, Poland. (2) Methods: This retrospective study included 1112 patients, who were made a tentative or an established diagnosis of acute or subacute onset of neurological deficits. The evaluation was based on medical history, neurological examination, laboratory and radiographic results and fulfilment of diagnosis criteria. (3) Results: Up to 1.62 percent of patients diagnosed with white matter lesions and up to 2.2% of the patients previously diagnosed with MS may suffer from NMOSD. The duration of delayed diagnosis is longer for males, despite the earlier age of onset. Seropositive cases for antibodies against aquaporin-4 have worse prognosis for degree of disability. (4) Conclusions: Underdiagnosis or misdiagnosis in NMOSD still remains a problem in clinical practice and has important implications for patients. The incorrect diagnosis is caused by atypical presentation or NMOSD-mimics; however, covariates such as gender, onset and diagnosis age may also have an influence.
Collapse
Affiliation(s)
- Anna K. Szewczyk
- Doctoral School, Medical University of Lublin, ul. Chodźki 7, 20-093 Lublin, Poland
- Department of Neurology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland;
| | - Ewa Papuć
- Department of Neurology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland;
| | - Krystyna Mitosek-Szewczyk
- Department of Child Neurology, Medical University of Lublin, ul. Profesora Antoniego Gebali 6, 20-093 Lublin, Poland;
| | - Michał Woś
- Department of Medical Informatics and Statistics with E-Learning Lab, ul. Jaczewskiego 4, 20-090 Lublin, Poland;
| | - Konrad Rejdak
- Department of Neurology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland;
| |
Collapse
|