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Lioudyno VI, Tsymbalova EA, Chernyavskaya EA, Scripchenko EY, Bisaga GN, Dmitriev AV, Abdurasulova IN. Association of Increased Homocysteine Levels with Impaired Folate Metabolism and Vitamin B Deficiency in Early-Onset Multiple Sclerosis. BIOCHEMISTRY. BIOKHIMIIA 2024; 89:562-573. [PMID: 38648773 DOI: 10.1134/s0006297924030143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/29/2023] [Accepted: 12/08/2023] [Indexed: 04/25/2024]
Abstract
The contents of homocysteine (HCy), cyanocobalamin (vitamin B12), folic acid (vitamin B9), and pyridoxine (vitamin B6) were analyzed and the genotypes of the main gene polymorphisms associated with folate metabolism (C677T and A1298C of the MTHFR gene, A2756G of the MTR gene and A66G of the MTRR gene) were determined in children at the onset of multiple sclerosis (MS) (with disease duration of no more than six months), healthy children under 18 years (control group), healthy adults without neurological pathology, adult patients with MS at the onset of disease, and adult patients with long-term MS. A significant increase in the HCy levels was found in children at the MS onset compared to healthy children of the corresponding age. It was established that the content of HCy in children has a high predictive value. At the same time, an increase in the HCy levels was not accompanied by the deficiency of vitamins B6, B9, and B12 in the blood. The lack of correlation between the laboratory signs of vitamin deficiency and HCy levels may be due to the polymorphic variants of folate cycle genes. An increased HCy level should be considered as a marker of functional disorders of folate metabolism accompanying the development of pathological process in pediatric MS. Our finding can be used to develop new approaches to the prevention of demyelination in children and treatment of pediatric MS.
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Affiliation(s)
| | | | | | - Elena Y Scripchenko
- Pediatric Research and Clinical Centre for Infectious Diseases, Saint Petersburg, 197022, Russia
| | - Gennadij N Bisaga
- Almazov National Medical Research Center, Saint Petersburg, 197341, Russia
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Ow N, Kuspinar A, Mayo NE. Age differences in trajectories of self-rated health of young people with Multiple Sclerosis. Mult Scler Relat Disord 2022; 57:103322. [PMID: 35158425 DOI: 10.1016/j.msard.2021.103322] [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: 04/30/2021] [Revised: 09/27/2021] [Accepted: 10/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Recent evidence has suggested an existence of a multiple sclerosis (MS) prodrome. Hence, some young adults with MS are very likely to have had symptoms in childhood or adolescence. It is, therefore, reasonable to assume that people aged under 25 years with MS might have had pediatric-onset. In contrast, young people aged between 26 and 35 are less likely to have had pediatric-onset. Contrasting these two groups of people could lead to valuable information about the impact of MS over time. The purpose of this study is to characterize how self-rated health (SRH) in young people with MS changed over time and to estimate the extent to which SRH differs between age groups (18 to 25 years and 26 to 35 years) and sex. METHODS This study utilized placebo arm data from the Multiple Sclerosis Outcome Assessment Consortium database. Responses to the RAND-36 SRH item of 393 participants were included. Group-based trajectory models (GBTM) were used to identify patterns of change over two years. Ordinal regression was performed to estimate whether these trajectory groups differed by age group, sex, and relapse event. RESULTS Results of GBTM showed that all groups were stable over time except one progressing from a rating of "very good" to "excellent". Posterior probabilities showed that 35% of people consistently rated their health "very good or excellent" and 2% consistently rated their health as "poor". Health perceptions differed across age groups (β = 0.5, OR: 1.7 CI: 1.1, 2.6) but not sex (β = -0.1, OR: 0.9 CI: 0.6 1.3). Compared to the younger group, people aged 26 to 35 years are 1.7 times more likely to rate their health poorer. People with relapses are also 2.2 times more likely to rate their health poorer (β = 0.8, OR: 2.2 CI: 1.5, 3.2). CONCLUSION Trajectories of SRH of young people with MS were relatively stable. In the absence of drug treatment, people in the younger group (<25 years) rated their health better than those in a slightly older group which is consistent with lower disability.
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Affiliation(s)
- Nikki Ow
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada; Center for Outcomes Research and Evaluation (CORE), The Research Institute of the McGill University Health Center (RI-MUHC), Montreal, QC, Canada.
| | - Ayse Kuspinar
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Nancy E Mayo
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada; Center for Outcomes Research and Evaluation (CORE), The Research Institute of the McGill University Health Center (RI-MUHC), Montreal, QC, Canada
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Deng R, Wu Y, Xu L, Liu K, Huang X, Zhang X. Clinical risk factors and prognostic model for idiopathic inflammatory demyelinating diseases after haploidentical hematopoietic stem cell transplantation in patients with hematological malignancies. Am J Hematol 2021; 96:1407-1419. [PMID: 34350623 DOI: 10.1002/ajh.26312] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/16/2021] [Accepted: 08/02/2021] [Indexed: 01/09/2023]
Abstract
Idiopathic inflammatory demyelinating diseases (IIDDs) of the central nervous system (CNS) are rare but serious neurological complications of haploidentical hematopoietic stem cell transplantation (haplo-HSCT). However, the risk factors and a method to predict the prognosis of post-transplantation CNS IIDDs are not available. This retrospective study first reviewed data from 4532 patients who received haplo-HSCT during 2008-2019 in our center, and 184 patients (4.1%) with IIDDs after haplo-HSCT were identified. Grades II to IV acute graft-versus-host disease (aGVHD) (p < 0.001) and chronic GVHD (cGVHD) (p = 0.009) were identified as risk factors for developing IIDDs after haplo-HSCT. We then divided the 184 IIDD patients into a derivation cohort and validation cohort due to transplantation time to develop and validate a model for predicting the prognosis of IIDDs. In the multivariate analysis of the derivation cohort, four candidate predictors were entered into the final prognostic model: cytomegalovirus (CMV) infection, Epstein-Barr virus (EBV) infection, IgG synthesis (IgG-syn) and spinal cord lesions. The prognostic model had an area under the receiver operating characteristic curve of 0.864 (95% CI: 0.803-0.925) in the internal validation cohort and 0.871 (95% CI: 0.806-0.931) in the external validation cohort. The calibration plots showed a high agreement between the predicted and observed outcomes. Decision curve analysis indicated that IIDD patients could benefit from the clinical application of the prognostic model. The identification of IIDD patients after allo-HSCT who have a poor prognosis might allow timely treatment and improve patient survival and outcomes.
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Affiliation(s)
- Rui‐Xin Deng
- Peking University People's Hospital Peking University Institute of Hematology Beijing China
- Collaborative Innovation Center of Hematology Peking University Beijing China
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing China
- National Clinical Research Center for Hematologic Disease Beijing China
| | - Ye‐Jun Wu
- Peking University People's Hospital Peking University Institute of Hematology Beijing China
- Collaborative Innovation Center of Hematology Peking University Beijing China
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing China
- National Clinical Research Center for Hematologic Disease Beijing China
| | - Lan‐Ping Xu
- Peking University People's Hospital Peking University Institute of Hematology Beijing China
- Collaborative Innovation Center of Hematology Peking University Beijing China
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing China
- National Clinical Research Center for Hematologic Disease Beijing China
| | - Kai‐Yan Liu
- Peking University People's Hospital Peking University Institute of Hematology Beijing China
- Collaborative Innovation Center of Hematology Peking University Beijing China
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing China
- National Clinical Research Center for Hematologic Disease Beijing China
| | - Xiao‐Jun Huang
- Peking University People's Hospital Peking University Institute of Hematology Beijing China
- Collaborative Innovation Center of Hematology Peking University Beijing China
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing China
- National Clinical Research Center for Hematologic Disease Beijing China
| | - Xiao‐Hui Zhang
- Peking University People's Hospital Peking University Institute of Hematology Beijing China
- Collaborative Innovation Center of Hematology Peking University Beijing China
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing China
- National Clinical Research Center for Hematologic Disease Beijing China
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Mrosková S, Klímová E, Majerníková Ľ, Tkáčová Ľ. Quality of Life of Children and Adolescents with Multiple Sclerosis-A Literature Review of the Quantitative Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168645. [PMID: 34444393 PMCID: PMC8392317 DOI: 10.3390/ijerph18168645] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/03/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022]
Abstract
Background: Multiple sclerosis (MS) is a chronic disease of the central nervous system that also develops in patients under 18 years of age. The disease negatively affects the quality of life (QoL) of children and adolescents. We conducted a literature review. The aim of the review was to identify the QoL of pediatric patients with MS and assess the factors determining their QoL. Methods: We analyzed studies published between 2000 and 2020 in PubMed, Scopus, Science Direct, Web of Science, and EBSCO databases. Results: In all, 17 studies were included in the review. The most common tool in assessing QoL was the generic module PedsQL. The range of mean/median global score of QoL was 53.8–81.7. The worst QoL was dominantly reported in the school and emotional spheres, on the contrary, the disease’s least determined area of QoL was the social and physical dimension. In particular, disability and fatigue were important predictors of QoL. Conclusions: MS negatively affects the school and emotional spheres in particular, so it is important to pay greater attention to these spheres of life of MS patients. As the review studies pay insufficient attention to the analysis of positive factors and their impact on the QoL of MS patients, research should integrate these phenomena. The use of MS-targeted tools in future research in the pediatric MS population is also appropriate.
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Affiliation(s)
- Slávka Mrosková
- Department of Nursing, Faculty of Health Care, University of Prešov, Partizánska 1, 08001 Prešov, Slovakia; (Ľ.M.); (Ľ.T.)
- Correspondence: ; Tel.: +421-51-75-62-462
| | - Eleonóra Klímová
- Department of Physiotherapy, Faculty of Health Care, University of Prešov, Partizánska 1, 08001 Prešov, Slovakia;
| | - Ľudmila Majerníková
- Department of Nursing, Faculty of Health Care, University of Prešov, Partizánska 1, 08001 Prešov, Slovakia; (Ľ.M.); (Ľ.T.)
| | - Ľubomíra Tkáčová
- Department of Nursing, Faculty of Health Care, University of Prešov, Partizánska 1, 08001 Prešov, Slovakia; (Ľ.M.); (Ľ.T.)
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Longitudinal analysis of disability outcomes among young people with MS. Mult Scler Relat Disord 2021; 52:102966. [PMID: 33934012 DOI: 10.1016/j.msard.2021.102966] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 04/07/2021] [Accepted: 04/10/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND The age of onset of MS appears to influence the course of disease progression and people with younger age of onset might have a different disability trajectory. OBJECTIVES To identify longitudinal patterns of disability progression, as measured by changes in the Multiple Sclerosis Functional Composite (MSFC), of young people in MS drug trials and to estimate the extent to which disability progression differ in two age groups (≤25 years and 26 - 35 years). METHODS Data from the Multiple Sclerosis Outcomes Assessment Consortium (MSOAC) was used. Longitudinal patterns on the MSFC were identified using group-based trajectory models (GBTM). For difference between the expected and observed proportions of people with pediatric-onset MS chi-square statistic was used. Linear mixed models were used to estimate the average change in performance over time, age and sex. RESULTS GBTM results showed little variability in performance over time. Mixed modeling showed that the younger group performed better for gait speed, dexterity, and cognition. Men performed poorer on dexterity and cognition. Distribution of people with pediatric-onset MS differed from expected on dexterity, cognition, and the EDSS. CONCLUSIONS The combined use of trajectory models and linear mixed models provided rich information about the variability in function over time.
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Boziki M, Sintila SA, Ioannidis P, Grigoriadis N. Biomarkers in Rare Demyelinating Disease of the Central Nervous System. Int J Mol Sci 2020; 21:ijms21218409. [PMID: 33182495 PMCID: PMC7665127 DOI: 10.3390/ijms21218409] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/06/2020] [Accepted: 11/07/2020] [Indexed: 12/29/2022] Open
Abstract
Rare neurological diseases are a heterogeneous group corresponding approximately to 50% of all rare diseases. Neurologists are among the main specialists involved in their diagnostic investigation. At the moment, a consensus guideline on which neurologists may base clinical suspicion is not available. Moreover, neurologists need guidance with respect to screening investigations that may be performed. In this respect, biomarker research has emerged as a particularly active field due to its potential applications in clinical practice. With respect to autoimmune demyelinating diseases of the Central Nervous System (CNS), although these diseases occur in the frame of organ-specific autoimmunity, pathology of the disease itself is orchestrated among several anatomical and functional compartments. The differential diagnosis is broad and includes, but is not limited to, rare neurological diseases. Multiple Sclerosis (MS) needs to be differentially diagnosed from rare MS variants, Acute Disseminated Encephalomyelitis (ADEM), the range of Neuromyelitis Optica Spectrum Disorders (NMOSDs), Myelin Oligodendrocyte Glycoprotein (MOG) antibody disease and other systemic inflammatory diseases. Diagnostic biomarkers may facilitate timely diagnosis and proper disease management, preventing disease exacerbation due to misdiagnosis and false treatment. In this review, we will describe advances in biomarker research with respect to rare neuroinflammatory disease of the CNS.
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Tjernberg I, Johansson M, Henningsson AJ. Diagnostic performance of cerebrospinal fluid free light chains in Lyme neuroborreliosis - a pilot study. Clin Chem Lab Med 2020; 57:2008-2018. [PMID: 31199760 DOI: 10.1515/cclm-2019-0315] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/18/2019] [Indexed: 11/15/2022]
Abstract
Background The aim of this study was to evaluate the diagnostic performance of cerebrospinal fluid (CSF) free light chains (FLCs) in the diagnosis of Lyme neuroborreliosis (LNB). Methods Serum and CSF levels of κ- and λ-FLC, albumin and total concentration of immunoglobulin M (IgM) were determined together with CSF chemokine CXCL13 in 23 patients with definite LNB, 35 inflammatory neurological disease control (INDC) and 18 non-inflammatory control (NIC) patients. Indices and intrathecal fractions (IFs) of FLC and IgM were calculated. Results Significant differences in FLC indices and IFs were found between the LNB group and both control groups, p ≤ 0.007. Sensitivity of intrathecal κ- and λ-FLC synthesis reached 78%-87% in LNB patients with a specificity of 94%-100% in NIC patients, whereas specificity in INDC patients was 69%. The corresponding frequencies of positive results for IF and index of IgM and CSF CXCL13 in these three diagnostic groups were 74%-96% in LNB patients, 0% in NIC patients and 3%-6% in INDC patients at the chosen cut-off levels. Conclusions The findings of this study show a moderate to high sensitivity of CSF κ- and λ-FLC in LNB patients with a high specificity in NIC patients. However, overlap in CSF κ- and λ-FLC levels between LNB and INDC patients calls for caution in the interpretation and limits the diagnostic usefulness in the LNB diagnosis. CSF CXCL13 appears to be the most valuable additional biomarker of LNB aside from routine parameters such as CSF pleocytosis and anti-Borrelia antibody index.
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Affiliation(s)
- Ivar Tjernberg
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Clinical Chemistry and Transfusion Medicine, Region Kalmar County, Kalmar, Sweden
| | - Marcus Johansson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Clinical Microbiology, Region Kalmar County, Kalmar, Sweden
| | - Anna J Henningsson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Clinical Microbiology, Region Jönköping County, Jönköping, Sweden.,Clinical Microbiology, Region Östergötland, Linköping, Sweden
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Mirmosayyeb O, Brand S, Barzegar M, Afshari-Safavi A, Nehzat N, Shaygannejad V, Sadeghi Bahmani D. Clinical Characteristics and Disability Progression of Early- and Late-Onset Multiple Sclerosis Compared to Adult-Onset Multiple Sclerosis. J Clin Med 2020; 9:jcm9051326. [PMID: 32370288 PMCID: PMC7290335 DOI: 10.3390/jcm9051326] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/26/2020] [Accepted: 04/27/2020] [Indexed: 12/25/2022] Open
Abstract
Background: Compared to the adult onset of multiple sclerosis (AOMS), both early-onset (EOMS) and late-onset (LOMS) are much less frequent, but are often under- or misdiagnosed. The aims of the present study were: 1. To compare demographic and clinical features of individuals with EOMS, AOMS and LOMS, and 2. To identify predictors for disability progression from relapsing remitting MS (RRMS) to secondary progressive MS (SPMS). Method: Data were taken from the Isfahan Hakim MS database. Cases were classified as EOMS (MS onset ≤18 years), LOMS (MS onset >50 years) and AOMS (MS >18 and ≤50 years). Patients’ demographic and clinical (initial symptoms; course of disease; disease patterns from MRI; disease progress) information were gathered and assessed. Kaplan–Meier and Cox proportional hazard regressions were conducted to determine differences between the three groups in the time lapse in conversion from relapsing remitting MS to secondary progressive MS. Results: A total of 2627 MS cases were assessed; of these 127 were EOMS, 84 LOMS and 2416 AOMS. The mean age of those with EOMS was 14.5 years; key symptoms were visual impairments, brain stem dysfunction, sensory disturbances and motor dysfunctions. On average, 24.6 years after disease onset, 14.2% with relapsing remitting MS (RRMS) were diagnosed with secondary progressive MS (SPMS). The key predictor variable was a higher Expanded Disability Status Scale (EDSS) score at disease onset. Compared to individuals with AOMS and LOMS, those with EOMS more often had one or two relapses in the first two years, and more often gadolinium-enhancing brain lesions. For individuals with AOMS, mean age was 29.4 years; key symptoms were sensory disturbances, motor dysfunctions and visual impairments. On average, 20.5 years after disease onset, 15.6% with RRMS progressed to SPMS. The key predictors at disease onset were: a higher EDSS score, younger age, a shorter inter-attack interval and spinal lesions. Compared to individuals with EOMS and LOMS, individuals with AOMS more often had either no or three and more relapses in the first two years. For individuals with LOMS, mean age was 53.8 years; key symptoms were motor dysfunctions, sensory disturbances and visual impairments. On average, 14 years after disease onset, 25.3% with RRMS switched to an SPMS. The key predictors at disease onset were: occurrence of spinal lesions and spinal gadolinium-enhancement. Compared to individuals with EOMS and AOMS, individuals with LOMS more often had no relapses in the first two years, and higher EDSS scores at disease onset and at follow-up. Conclusion: Among a large sample of MS sufferers, cases with early onset and late onset are observable. Individuals with early, adult and late onset MS each display distinct features which should be taken in consideration in their treatment.
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Affiliation(s)
- Omid Mirmosayyeb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran; (O.M.); (M.B.); (N.N.)
- Universal Council of Epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran 14197-33151, Iran
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Serge Brand
- Center of Depression, Stress and Sleep Disorders, Psychiatric Clinics (UPK), University of Basel, 4002 Basel, Switzerland; (S.B.); (D.S.B.)
- Division of Sport Science and Psychosocial Health, Department of Sport, Exercise, and Health, University of Basel, 4032 Basel, Switzerland
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences (KUMS), Kermanshah 6719851351, Iran
- Sleep Disorders Research Center, Health Institute, Kermanshah University of Medical Sciences (KUMS), Kermanshah 6719851351, Iran
- School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran 1416753955, Iran
| | - Mahdi Barzegar
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran; (O.M.); (M.B.); (N.N.)
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Alireza Afshari-Safavi
- Department of Biostatistics and Epidemiology, Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd 74877-94149, Iran;
| | - Nasim Nehzat
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran; (O.M.); (M.B.); (N.N.)
- Universal Council of Epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran 14197-33151, Iran
- Faculty of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz 6135715794, Iran
| | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran; (O.M.); (M.B.); (N.N.)
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
- Correspondence:
| | - Dena Sadeghi Bahmani
- Center of Depression, Stress and Sleep Disorders, Psychiatric Clinics (UPK), University of Basel, 4002 Basel, Switzerland; (S.B.); (D.S.B.)
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences (KUMS), Kermanshah 6719851351, Iran
- Departments of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL 35209, USA
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No evidence of disease activity including cognition (NEDA-3 plus) in naïve pediatric multiple sclerosis patients treated with natalizumab. J Neurol 2019; 267:100-105. [PMID: 31562558 DOI: 10.1007/s00415-019-09554-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/18/2019] [Accepted: 09/21/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Pediatric-onset multiple sclerosis (POMS) is characterized by high inflammatory activity, aggressive course and early development of physical and cognitive disability. A highly effective early treatment must be considered in POMS. OBJECTIVE To evaluate safety and efficacy of natalizumab (NTZ) in naïve POMS. METHODS 20 naïve POMS (13F, 7 M; mean age: 13.8 ± 2.7 years) were treated with NTZ for at least 24 months (mean number of infusions: 42 ± 20). No evidence of disease activity (NEDA)-3 plus status, i.e., no relapse, no disease progression (EDSS score), no radiological activity and no cognitive decline, was evaluated. RESULTS After 2 years of NTZ treatment, a significant reduction in the mean EDSS score (p < 0.0001) was observed in the whole cohort. During the follow-up, evidence of disease activity on MRI was observed in two patients (10%) and a mild decline in cognition was observed in other two. No patient had clinical relapse. At the time of last visit NEDA-3 plus status was maintained in 16 (80%) patients. No major adverse event was observed. CONCLUSION Early treatment of aggressive POMS with NTZ proved to be highly effective in achieving and maintaining the NEDA-3 plus status. Our data support the use of NTZ as first treatment choice in POMS.
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