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Canavese C, Favole I, D'Alessandro R, Vercellino F, Papa A, Podestà B, Longaretti F, Brustia F, Rampone S, Benedini F, Giraudo M, Tocchet A. Acquired Demyelinating Syndromes of the Central Nervous System in Children: The Importance of Regular Follow-up in the First Year After Onset. J Child Neurol 2023; 38:537-549. [PMID: 37574786 DOI: 10.1177/08830738231193495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
AIM We reviewed the clinical features of a sample of pediatric acquired demyelinating syndromes with the purpose of determining the appropriate protocol for follow-up after the first episode. METHODS A multicenter retrospective observational study was conducted on a cohort of 40 children diagnosed with a first episode of acquired demyelinating syndrome over the period 2012-2021. Patients were evaluated with clinical and neuroradiologic assessment after 3, 6, and 12 months, with a median follow-up of 4.0 years. RESULTS At the first acquired demyelinating syndrome episode, 18 patients (45%) were diagnosed with acute disseminated encephalomyelitis, 18 (45%) with clinical isolated syndrome, and 4 (10%) with multiple sclerosis. By month 12, 12 patients (30%) had progressed from an initial diagnosis of acute disseminated encephalomyelitis (2) or clinical isolated syndrome (10) to multiple sclerosis. Of these, 6 had clinical relapse and 6 radiologic relapse only. The first relapse occurred after a median of 3 months. Among the patients who had evolved toward multiple sclerosis, there was a prevalence of females (P = .014), higher oligoclonal bands positivity (P = .009), and older median age (P < .001) as compared with those who had remained stable. INTERPRETATION Both clinical and radiologic follow-up of children with acquired demyelinating syndromes is crucial, especially during the first year after acute onset, for early identification of multiple sclerosis and prompt initiation of disease-modifying treatment to delay axonal damage and to limit disability.
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Affiliation(s)
- Carlotta Canavese
- Child and Adolescent Neuropsychiatry Unit, University of Torino, Regina Margherita Hospital, Torino, Italy
| | - Irene Favole
- Child and Adolescent Neuropsychiatry Unit, University of Torino, Regina Margherita Hospital, Torino, Italy
| | - Rossella D'Alessandro
- Child and Adolescent Neuropsychiatry Unit, University of Torino, Regina Margherita Hospital, Torino, Italy
| | - Fabiana Vercellino
- Child Neuropsychiatry Unit, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Amanda Papa
- Infantile Neuropsychiatric Unit, University Hospital Maggiore della Carità, Novara, Italy
| | - Barbara Podestà
- Child Neurology and Psychiatry Unit, S. Croce and Carle Hospital, Cuneo, Italy
| | | | - Francesca Brustia
- Infantile Neuropsychiatric Unit, University Hospital Maggiore della Carità, Novara, Italy
| | - Sara Rampone
- Child Neuropsychiatry Unit, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Francesca Benedini
- Child and Adolescent Neuropsychiatry Unit, University of Torino, Regina Margherita Hospital, Torino, Italy
| | - Mariachiara Giraudo
- Child and Adolescent Neuropsychiatry Unit, University of Torino, Regina Margherita Hospital, Torino, Italy
| | - Aba Tocchet
- Child and Adolescent Neuropsychiatry Unit, University of Torino, Regina Margherita Hospital, Torino, Italy
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Abdel-Mannan O, Absoud M, Benetou C, Hickson H, Hemingway C, Lim M, Wright S, Hacohen Y, Wassmer E. Incidence of paediatric multiple sclerosis and other acquired demyelinating syndromes: 10-year follow-up surveillance study. Dev Med Child Neurol 2022; 64:502-508. [PMID: 34693523 DOI: 10.1111/dmcn.15098] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 12/01/2022]
Abstract
AIM To describe a 10-year follow-up of children (<16y) with acquired demyelinating syndromes (ADS) from a UK-wide prospective surveillance study. METHOD Diagnoses were retrieved from the patients' records via the patients' paediatric or adult neurologist using a questionnaire. Demyelinating phenotypes at follow-up were classified by an expert review panel. RESULTS Twenty-four out of 125 (19.2%) children (64 males, 61 females; median age 10y, range 1y 4mo-15y 11mo), identified in the original study, were diagnosed with multiple sclerosis (incidence of 2.04/million children/year); 23 of 24 fulfilled 2017 McDonald criteria at onset. Aquaporin-4-antibody neuromyelitis optica spectrum disorders were diagnosed in three (2.4%, 0.26/million children/year), and relapsing myelin oligodendrocyte glycoprotein antibody-associated disease in five (4%, 0.43/million children/year). Three out of 125 seronegative patients relapsed and 85 of 125 (68%) remained monophasic over 10 years. Five of 125 patients (4%) originally diagnosed with ADS were reclassified during follow-up: three children diagnosed initially with acute disseminated encephalomyelitis were subsequently diagnosed with acute necrotising encephalopathy (RAN-binding protein 2 mutation), primary haemophagocytic lymphohistiocytosis (Munc 13-4 gene inversion), and anti-N-methyl-d-aspartate receptor encephalitis. One child initially diagnosed with optic neuritis was later diagnosed with vitamin B12 deficiency, and one presenting with transverse myelitis was subsequently diagnosed with Sjögren syndrome. INTERPRETATION The majority of ADS presentations in children are monophasic, even at 10-year follow-up. Given the implications for treatment strategies, multiple sclerosis and central nervous system autoantibody mimics warrant extensive investigation.
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Affiliation(s)
- Omar Abdel-Mannan
- Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.,Department of Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Michael Absoud
- Children's Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London, UK
| | - Christina Benetou
- Children's Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London, UK
| | - Helga Hickson
- Department of Neurology, Birmingham Children's Hospital, Birmingham, UK
| | - Cheryl Hemingway
- Department of Neurology, Great Ormond Street Hospital for Children, London, UK.,Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Ming Lim
- Children's Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London, UK
| | - Sukhvir Wright
- Department of Neurology, Birmingham Children's Hospital, Birmingham, UK.,Institute of Health and Neurodevelopment, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Yael Hacohen
- Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.,Department of Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Evangeline Wassmer
- Department of Neurology, Birmingham Children's Hospital, Birmingham, UK.,Institute of Health and Neurodevelopment, College of Health and Life Sciences, Aston University, Birmingham, UK
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Pugliatti M, Ferri C. The epidemiology of acquired demyelinating syndrome in children: a complex opportunity to investigate the etiopathogenesis of multiple sclerosis. Dev Med Child Neurol 2022; 64:409-410. [PMID: 34904715 PMCID: PMC9300026 DOI: 10.1111/dmcn.15119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 11/29/2022]
Abstract
This commentary is on the original article by Abdel‐Mannan et al. on pages 502–508 of this issue.
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Affiliation(s)
- Maura Pugliatti
- Department of Neuroscience and RehabilitationUniversity of FerraraFerraraItaly
| | - Caterina Ferri
- Department of Neuroscience and RehabilitationUniversity of FerraraFerraraItaly
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