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Carotenuto A, Di Monaco C, Papetti L, Borriello G, Signoriello E, Masciulli C, Tomassini V, De Luca G, Ianniello A, Lus G, Novarella F, Spiezia AL, Di Somma D, Moccia M, Petracca M, Iacovazzo C, Servillo G, Portaccio E, Triassi M, Amato MP, Pozzilli C, Valeriani M, Brescia Morra V, Lanzillo R. Pediatric-onset Multiple Sclerosis treatment: a multicentre observational study comparing natalizumab with fingolimod. J Neurol 2024:10.1007/s00415-024-12610-y. [PMID: 39177751 DOI: 10.1007/s00415-024-12610-y] [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: 06/07/2024] [Revised: 07/17/2024] [Accepted: 07/21/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Pediatric-onset Multiple Sclerosis (POMS) patients show more inflammatory disease compared with adult-onset MS. However, highly effective treatments are limited with only fingolimod being approved in Italy and natalizumab prescribed as off-label treatment. OBJECTIVES to compare the efficacy of natalizumab versus fingolimod in POMS. METHODS This is an observational longitudinal multicentre study including natalizumab- and fingolimod-treated POMS patients (N-POMS and F-POMS, respectively). We collected Annual Relapse Rate (ARR), Expanded Disability Status Scale (EDSS), Symbol Digit Modality Test (SDMT), and MRI activity at baseline (T0), 12-18 months (T1), and last available observation (T2). RESULTS We enrolled 57 N-POMS and 27 F-POMS patients from six Italian MS Centres. At T0, N-POMS patients showed higher ARR (p = 0.03), higher EDSS (p = 0.003) and lower SDMT (p = 0.04) at baseline compared with F-POMS. Between T0 and T1 ARR improved for both N-POMS and F-POMS (p < 0.001), while EDSS (p < 0.001) and SDMT (p = 0.03) improved only for N-POMS. At T2 (66.1 ± 55.4 months) we collected data from 42 out of 57 N-POMS patients showing no further ARR decrease. CONCLUSION Both natalizumab and fingolimod showed high and sustained efficacy in controlling relapses and natalizumab also associated to a disability decrease in POMS. This latter effect might be partly mediated by the high inflammatory activity at baseline in N-POMS.
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Affiliation(s)
- Antonio Carotenuto
- Department of Neuroscience, Reproductive Science and Odontostomatology, Multiple Sclerosis Clinical Care and Research Centre, Federico II University, Naples, Italy.
| | - Cristina Di Monaco
- Department of Neuroscience, Reproductive Science and Odontostomatology, Multiple Sclerosis Clinical Care and Research Centre, Federico II University, Naples, Italy
| | - Laura Papetti
- Developmental Neurology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giovanna Borriello
- Department of Public Health, University "Federico II" of Naples, Naples, Italy
| | - Elisabetta Signoriello
- Second Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania, Naples, Italy
| | | | - Valentina Tomassini
- Multiple Sclerosis Centre, Clinical Neurology, SS. Annunziata University Hospital, Chieti, Italy
- Institute for Advanced Biomedical Technologies (ITAB), Department of Neurosciences, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Giovanna De Luca
- Multiple Sclerosis Centre, Clinical Neurology, SS. Annunziata University Hospital, Chieti, Italy
| | | | - Giacomo Lus
- Second Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania, Naples, Italy
| | - Federica Novarella
- Department of Neuroscience, Reproductive Science and Odontostomatology, Multiple Sclerosis Clinical Care and Research Centre, Federico II University, Naples, Italy
| | - Antonio Luca Spiezia
- Department of Neuroscience, Reproductive Science and Odontostomatology, Multiple Sclerosis Clinical Care and Research Centre, Federico II University, Naples, Italy
| | - Dario Di Somma
- Department of Neuroscience, Reproductive Science and Odontostomatology, Multiple Sclerosis Clinical Care and Research Centre, Federico II University, Naples, Italy
| | - Marcello Moccia
- Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy
| | - Maria Petracca
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Carmine Iacovazzo
- Department of Neuroscience, Reproductive Science and Odontostomatology, Multiple Sclerosis Clinical Care and Research Centre, Federico II University, Naples, Italy
| | - Giuseppe Servillo
- Department of Neuroscience, Reproductive Science and Odontostomatology, Multiple Sclerosis Clinical Care and Research Centre, Federico II University, Naples, Italy
| | - Emilio Portaccio
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Maria Triassi
- Department of Public Health, University "Federico II" of Naples, Naples, Italy
| | - Maria Pia Amato
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Carlo Pozzilli
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Massimiliano Valeriani
- Developmental Neurology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- System Medicine Department, Tor Vergata University of Rome, Rome, Italy
- Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
| | - Vincenzo Brescia Morra
- Department of Neuroscience, Reproductive Science and Odontostomatology, Multiple Sclerosis Clinical Care and Research Centre, Federico II University, Naples, Italy
| | - Roberta Lanzillo
- Department of Neuroscience, Reproductive Science and Odontostomatology, Multiple Sclerosis Clinical Care and Research Centre, Federico II University, Naples, Italy
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2
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Vanderschelden RK, Benjamin NL, Shurin MR, Shelton L, Wheeler SE. Clinical laboratory test utilization of CSF oligoclonal bands and IgG index in a tertiary pediatric hospital. Clin Biochem 2024; 131-132:110803. [PMID: 39053601 DOI: 10.1016/j.clinbiochem.2024.110803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 07/02/2024] [Accepted: 07/22/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Criteria developed for the diagnosis of multiple sclerosis (MS) in adults are also used in the pediatric setting. However, differential diagnosis in pediatric-onset MS (POMS) is distinct from that of adult-onset MS. There is little literature characterizing the utility of oligoclonal bands (OCB) and IgG index in differentiating POMS from other childhood diseases with overlapping clinical presentation which can require immediate treatment. METHODS A retrospective review of all MS panels resulted between March 2022 and May 2023 on patients age ≤ 18 years at one tertiary care pediatric hospital in the northeastern United States was performed with pediatric neurology collaboration to characterize clinical utility (n = 85 cases). RESULTS Demyelinating diseases accounted for 31 of 85 total cases (36.5%), 12 of these cases were POMS (14%). Other diagnoses consisted of psychiatric etiologies (17.6%), infectious meningitis/encephalitis (5.9%), and migraine (5.9%). Elevated IgG index was seen in 67% of those with demyelinating diseases, versus only 13% of those with other conditions. Unique OCBs were found in 41% of those with demyelinating diseases, versus only 9% of those with other conditions. Fourteen of 15 patients (93.3%) with psychiatric conditions had normal MS panels. CONCLUSIONS Patients with demyelinating diseases were more likely to have elevated IgG index and unique OCBs versus patients with other conditions. For pediatric hospitals without in-house OCB evaluation, implementation of an in-house IgG index may serve as a rapid screen for differentials that include demyelinating diseases while awaiting OCB results, in the appropriate clinical context. IMPACT STATEMENT IgG index and CSF oligoclonal bands are important tools in the diagnosis of patients with suspected Multiple Sclerosis (MS). In the pediatric population, these markers are used to differentiate pediatric-onset MS (POMS) from other neurologic, psychiatric, and inflammatory diseases that display clinical overlap. The use of these markers in differentiating these conditions has not been thoroughly investigated. We examined the associations between abnormal markers and final diagnoses in pediatric patients undergoing testing for POMS in order to identify trends that may enhance ordering and reporting practices.
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Affiliation(s)
| | | | - Michael R Shurin
- University of Pittsburgh Medical Center, Department of Pathology, Pittsburgh, PA, USA; University of Pittsburgh, School of Medicine, Department of Pathology, Pittsburgh, PA, USA
| | - Levi Shelton
- University of Pittsburgh, School of Medicine, Department of Pediatrics, Pittsburgh, PA, USA
| | - Sarah E Wheeler
- University of Pittsburgh Medical Center, Department of Pathology, Pittsburgh, PA, USA; University of Pittsburgh, School of Medicine, Department of Pathology, Pittsburgh, PA, USA.
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3
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Mirza AI, Zhu F, Knox N, Black LJ, Daly A, Bonner C, Van Domselaar G, Bernstein CN, Marrie RA, Hart J, Yeh EA, Bar-Or A, O'Mahony J, Zhao Y, Hsiao W, Banwell B, Waubant E, Tremlett H. Mediterranean diet and associations with the gut microbiota and pediatric-onset multiple sclerosis using trivariate analysis. COMMUNICATIONS MEDICINE 2024; 4:148. [PMID: 39030379 PMCID: PMC11271616 DOI: 10.1038/s43856-024-00565-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 07/02/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND The interplay between diet and the gut microbiota in multiple sclerosis (MS) is poorly understood. We aimed to assess the interrelationship between diet, the gut microbiota, and MS. METHODS We conducted a case-control study including 95 participants (44 pediatric-onset MS cases, 51 unaffected controls) enrolled from the Canadian Pediatric Demyelinating Disease Network study. All had completed a food frequency questionnaire ≤21-years of age, and 59 also provided a stool sample. RESULTS Here we show that a 1-point increase in a Mediterranean diet score is associated with 37% reduced MS odds (95%CI: 10%-53%). Higher fiber and iron intakes are also associated with reduced MS odds. Diet, not MS, explains inter-individual gut microbiota variation. Several gut microbes abundances are associated with both the Mediterranean diet score and having MS, and these microbes are potential mediators of the protective associations of a healthier diet. CONCLUSIONS Our findings suggest that the potential interaction between diet and the gut microbiota is relevant in MS.
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Affiliation(s)
- Ali I Mirza
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Feng Zhu
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, BC, Canada
| | - Natalie Knox
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Lucinda J Black
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
- Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Alison Daly
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - Christine Bonner
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Gary Van Domselaar
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Janace Hart
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - E Ann Yeh
- Department of Pediatrics (Neurology), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Amit Bar-Or
- Centre for Neuroinflammation and Experimental Therapeutics and Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Julia O'Mahony
- Department of Pediatrics (Neurology), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Yinshan Zhao
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, BC, Canada
| | - William Hsiao
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Brenda Banwell
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Division of Child Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Emmanuelle Waubant
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Helen Tremlett
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, BC, Canada.
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4
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Chen S, A B, Koukou G, Wendel EM, Thiels C, Baumann M, Lechner C, Blaschek A, Della Marina A, Classen G, Stüve B, Kauffmann B, Kapanci T, Mayer B, Otto M, Rostásy K. Frequency of an intrathecal IgM synthesis and MRZ reaction in children with MS. Eur J Paediatr Neurol 2024; 50:51-56. [PMID: 38636242 DOI: 10.1016/j.ejpn.2024.04.005] [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] [Received: 12/09/2023] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic inflammatory and demyelinating disease of the CNS. An intrathecal IgM synthesis is associated with a more rapid progression of MS and the intrathecal immune response to measles -, rubella -and varicella zoster virus (MRZR) which, if present, increases the likelihood of a diagnosis of MS in adults. OBJECTIVE To evaluate the frequency of an intrathecal IgM synthesis and MRZR in children with MS. MethodsChildren with MS and a data set including clinical and treatment history, MRI at onset, in addition to a CSF analysis, and determination of antibody index (AI) of measles, rubella, and zoster antibodies, were eligible. The presence of an intrathecal IgM synthesis and/or a positive MRZ reaction were compared to biomarkers of a more progressive disease course. RESULTS In 75 children with MS, OCBs were present in 93.3 %). 49,2 % experienced their first relapse within 6 months. 50.7 % had a total lesion load of more than 10 lesions in the first brain MRI. Spinal lesions were identified in 64 %. 23.5 % had a positive MRZR and 40.3 % an intrathecal IgM synthesis. No significant associations were detected between the presence of an intrathecal IgM synthesis and MRZR and parameters including the relapse rate in the first two years. CONCLUSION An intrathecal IgM synthesis and a positive MRZR are found in a subset of MS children but are not associated with markers associated with a poor prognosis.
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Affiliation(s)
- S Chen
- Department of Pediatric Neurology, Vestische Kinder- und Jugendklinik Datteln, University Witten/Herdecke, Datteln, Germany
| | - Bertolini A
- Department of Pediatric Neurology, Vestische Kinder- und Jugendklinik Datteln, University Witten/Herdecke, Datteln, Germany
| | - G Koukou
- Department of Pediatric Neurology, Vestische Kinder- und Jugendklinik Datteln, University Witten/Herdecke, Datteln, Germany
| | - E M Wendel
- Department of Neuropediatrics, Olgahospital/Klinikum Stuttgart Pediatrics, Stuttgart, Germany
| | - C Thiels
- Department of Neuropediatrics, University Children's Hospital, Ruhr-University Bochum, Bochum, Germany
| | - M Baumann
- Department of Pediatrics I, Division of Pediatric Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - C Lechner
- Department of Pediatrics I, Division of Pediatric Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - A Blaschek
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner's Children's Hospital, University of Munich, Munich, Germany
| | - A Della Marina
- Department of Neuropediatrics, Developmental Neurology and Social Pediatrics, Centre for Translational Neuro- and Behavioral Sciences, University Duisburg-Essen, Essen, Germany
| | - G Classen
- Department of Neuropediatrics, Evangelisches Klinikum Bethel, University of Bielefeld, Bielefeld, Germany
| | - B Stüve
- Department for Neuropediatrics, DRK Children's Hospital Siegen, Siegen, Germany
| | - B Kauffmann
- Department of Neuropediatrics, Hospital Bremen Mitte, Bremen, Germany
| | - T Kapanci
- Department of Pediatric Neurology, Vestische Kinder- und Jugendklinik Datteln, University Witten/Herdecke, Datteln, Germany
| | - B Mayer
- Institute of Epidemiology and Medical Biometry, University Ulm, Germany
| | - M Otto
- Department of Neurology, Martin-Luther-University Hospital of Halle-Wittenberg, Halle, Germany
| | - K Rostásy
- Department of Pediatric Neurology, Vestische Kinder- und Jugendklinik Datteln, University Witten/Herdecke, Datteln, Germany.
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5
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Sandesjö F, Tremlett H, Fink K, Marrie RA, Zhu F, Wickström R, McKay KA. Incidence rate and prevalence of pediatric-onset multiple sclerosis in Sweden: A population-based register study. Eur J Neurol 2024; 31:e16253. [PMID: 38369806 PMCID: PMC11236061 DOI: 10.1111/ene.16253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/18/2024] [Accepted: 02/04/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND AND PURPOSE Pediatric-onset multiple sclerosis (PoMS) is associated with high health care use. To plan resource allocation for this patient group, knowledge of the incidence rate and prevalence is important. However, such studies are scarce, few are population-based, and the methodology varies widely. We aimed to address this knowledge gap by performing a nationwide study of the incidence rate and prevalence of PoMS in Sweden, an area of high multiple sclerosis (MS) incidence and prevalence. METHODS MS cases were identified by linking two nationwide registers, the National Patient Register and the Swedish MS Registry. MS cases having their first central nervous system demyelinating event or MS clinical onset before age 18 years were classified as pediatric onset. Incidence rate and prevalence were estimated annually over the study period (2006-2016) for the total population and stratified by sex and age group (<12, 12-15, and 16-17 years). Temporal trends and ratios between sexes and age groups were estimated. RESULTS We identified 238 incident cases from 2006 to 2016, corresponding to an overall crude incidence rate of 1.12 per 100,000 person-years and an overall crude prevalence of 2.82 per 100,000 population. There was a higher incidence rate among females and the highest age category. The overall incidence rate and prevalence estimates remained stable during the study period. CONCLUSIONS Sweden exhibits a consistently high incidence rate and prevalence of PoMS that has remained stable over time. This knowledge serves as a tool to aid in planning resource allocation and health services for this patient population.
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Affiliation(s)
- Fredrik Sandesjö
- Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - Helen Tremlett
- Division of Neurology, Department of Medicine, The Djavad Mowafaghian Centre for Brain HealthUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Katharina Fink
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
| | - Ruth Ann Marrie
- Department of Internal MedicineDepartment of Community Health SciencesMax Rady College of Medicine, Rady Faculty of Health Sciences, University of ManitobaWinnipegManitobaCanada
| | - Feng Zhu
- Division of Neurology, Department of Medicine, The Djavad Mowafaghian Centre for Brain HealthUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Ronny Wickström
- Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - Kyla A. McKay
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
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Hulliger LF, Tscherter A, Kuehni CE, Bigi S. Protocol on establishing a national disease registry-Swiss Pediatric Inflammatory Brain Disease Registry. PLoS One 2024; 19:e0290908. [PMID: 38626083 PMCID: PMC11020937 DOI: 10.1371/journal.pone.0290908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 03/28/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Pediatric-onset inflammatory brain diseases are a group of potentially life-threatening central nervous system disorders. Overall, pediatric-onset inflammatory brain diseases are rare and therefore difficult to study. Patient registries are well suited to study the natural history of (rare) diseases and have markedly advanced the knowledge on pediatric-onset inflammatory brain diseases in other countries. Following their example, we established a national pediatric-onset inflammatory brain disease registry in Switzerland (Swiss-Ped-IBrainD). AIMS The Registry aims to describe epidemiology, demographics, diagnostics, management, and treatment, since these areas remain understudied in Switzerland. Additionally, we want to promote research by fostering the knowledge exchange between study centers and setting up studies such as national quality of life surveys. We further aim to facilitate the access to national and international studies for patients with a pediatric-onset inflammatory brain disease living and/or treated in Switzerland. METHODS The Swiss-Ped-IBrainD is a multicentric, population-based, observational cohort study (IRB number: 2019-00377) collaborating with 11 neuropediatric centers in Switzerland. Patient screening, information and recruitment is mainly conducted by the local principal investigators. The data collection is organized centrally by the Executive Office of the registry. The collected data is purely observational. Medical records are the primary data source. All patients who have been diagnosed with a pediatric-onset inflammatory brain disease since 2005 are eligible. We aim to include all pediatric-onset inflammatory brain disease patients living and/or treated in Switzerland who meet the inclusion criteria. Considering existing literature and our single-center experience we anticipate 300-400 eligible patients. STATUS Currently, all 11 neuropediatric centers have been initiated and are recruiting. As of the first of May 2023, we have identified 275 eligible participants and obtained informed consent from 101 patients and/or families. None of the informed patients and/or families have refused participation.
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Affiliation(s)
| | - Anne Tscherter
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Sandra Bigi
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Neuropediatrics, Lucerne Cantonal Hospital, Children’s Hospital of Central Switzerland, Luzern, Switzerland
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7
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Barzegar M, Vaheb S, Mirmosayyeb O, Ashtari F, Afshari-Safavi A, Adibi I, Shaygannejad A, Mazaheri S, Rahimi M, Shaygannejad V. Prevalence and incidence of multiple sclerosis in Isfahan, Iran between 1996 and 2021: A population-based study. Mult Scler Relat Disord 2024; 84:105479. [PMID: 38359695 DOI: 10.1016/j.msard.2024.105479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/18/2024] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND There has been no recent comprehensive epidemiological study on a large and stable population of multiple sclerosis (MS) in Isfahan. Therefore, we conducted this study to estimate the incidence and prevalence of MS in Isfahan province from 1996 to 2021. METHOD In this population-based study, we utilized the dataset from the Vice-Chancellor's Office of Isfahan University of Medical Sciences, which registers all people diagnosed with MS (PDWM) in Isfahan province, excluding those residing in Kashan city. We measured crude incidence and prevalence of MS, separated by sex, and based on age of MS onset, as well as changes in age of MS onset during observation. RESULTS A total of 9,909 PDWM were included in our study. The incidence during the time period of 1996-2000 was 5.4/100,000 (1.1/100,000 per year), which subsequently increased to 14.1 (2.8/100,000 per years) and 31.1 per 100,000 (6.2/100,000 per year) during 2001-2005 and 2006-2010, respectively. There was a further increase to 70.9/100,000 (14.2/100,000 per year) in 2011-2015, but it remained stable at 71.8/100,000 (12/100,000 per year) during the period of 2016-2021. In 2016, the age-standardized incidence rates of pediatric-onset, adult-onset, and late-onset MS were 1.8/100,000, 31.4/100,000, and 17.5/100,000, respectively. The prevalence of MS in 2021 was 183.9/100,000. The female/male new case ratio was 4.5 during 1996-2000, decreasing to 4.0, 3.9, 3.9, and 2.9 in the subsequent four five-year periods. The mean age of RRMS onset was 26.3 ± 8.1 between 1990 and 1999, 28.5 ± 8.3 during 2000-2009, and increased to 32.8 ± 9.6 in 2010-2019. CONCLUSION This study shows that Isfahan has one of the highest incidence rate and prevalence ratio of MS in the region. We observed an increase in the incidence rate during the first decade, followed by stability in the last two five- and six-year periods. Further studies are needed to identify the reasons behind the change in incidence of MS in Iran.
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Affiliation(s)
- Mahdi Barzegar
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Vaheb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Mirmosayyeb
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereshteh Ashtari
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Afshari-Safavi
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Biostatistics and Epidemiology, Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Iman Adibi
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Aysa Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahrbanoo Mazaheri
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Rahimi
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Shaygannejad
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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8
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Pierce Pucci JU, Soloria HM, Eye PG. Managing pediatric-onset multiple sclerosis in an austere setting: A case report. J Telemed Telecare 2024:1357633X241235701. [PMID: 38425268 DOI: 10.1177/1357633x241235701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Pediatric-onset multiple sclerosis (POMS) is the most common demyelinating disease in children. Patients suffer from physical disability, cognitive impairment, and psychosocial challenges. Management requires a multidisciplinary care team. Here we present a case of an 11-year-old boy with POMS who relocated to Guam prior to initiation of a disease-modifying treatment and who experienced a flare without immediate access to an MRI or a child neurologist. Care required the combined efforts of ophthalmology, pediatrics, and emergency medicine in Guam, real-time remote guidance by child neurology, and asynchronous collaboration with cardiology and child neurology. As a result, the immediate flare was accurately diagnosed and treated with steroids, the patient was started on Fingolimod, and an emergency management plan for future flares was constructed. This case illustrates the nuances of both the acute and chronic management of multiple sclerosis in a resource-limited setting and how a combination of synchronous and asynchronous telemedicine was able to achieve a satisfactory treatment plan.
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Affiliation(s)
| | - Heather M Soloria
- Department of Pediatrics, United States Naval Hospital Guam, Agana Heights, Guam
| | - Philip G Eye
- Department of Pediatrics, Tripler Army Medical Center, Honolulu, HI, USA
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Damer A, Chaudry E, Eftekhari D, Benseler SM, Safi F, Aviv RI, Tyrrell PN. Neuroimaging Scoring Tools to Differentiate Inflammatory Central Nervous System Small-Vessel Vasculitis: A Need for Artificial Intelligence/Machine Learning?-A Scoping Review. Tomography 2023; 9:1811-1828. [PMID: 37888736 PMCID: PMC10610796 DOI: 10.3390/tomography9050144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 10/28/2023] Open
Abstract
Neuroimaging has a key role in identifying small-vessel vasculitis from common diseases it mimics, such as multiple sclerosis. Oftentimes, a multitude of these conditions present similarly, and thus diagnosis is difficult. To date, there is no standardized method to differentiate between these diseases. This review identifies and presents existing scoring tools that could serve as a starting point for integrating artificial intelligence/machine learning (AI/ML) into the clinical decision-making process for these rare diseases. A scoping literature review of EMBASE and MEDLINE included 114 articles to evaluate what criteria exist to diagnose small-vessel vasculitis and common mimics. This paper presents the existing criteria of small-vessel vasculitis conditions and mimics them to guide the future integration of AI/ML algorithms to aid in diagnosing these conditions, which present similarly and non-specifically.
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Affiliation(s)
- Alameen Damer
- Department of Medical Imaging, University of Toronto, Toronto, ON M5T 1W7, Canada
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Emaan Chaudry
- Department of Medical Imaging, University of Toronto, Toronto, ON M5T 1W7, Canada
| | - Daniel Eftekhari
- Department of Medical Imaging, University of Toronto, Toronto, ON M5T 1W7, Canada
| | - Susanne M. Benseler
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Frozan Safi
- Department of Medical Imaging, University of Toronto, Toronto, ON M5T 1W7, Canada
| | - Richard I. Aviv
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Pascal N. Tyrrell
- Department of Medical Imaging, University of Toronto, Toronto, ON M5T 1W7, Canada
- Institute of Medical Science, Department of Statistical Sciences, University of Toronto, Toronto, ON M5G 1X6, Canada
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10
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Stratton C, Vassilopoulos A, Brenton JN, Potter K, Vargas W, Rumm H, Bartels A, Bailey M, Odonkor C, Stoll S, Zempsky EWT, Yeh EA, Makhani N. Interim guidelines for the assessment and treatment of pain in children with multiple sclerosis. Front Neurosci 2023; 17:1235945. [PMID: 37781253 PMCID: PMC10536169 DOI: 10.3389/fnins.2023.1235945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/23/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Pain in multiple sclerosis (MS) is common, but literature on pain in children with MS remains scarce. Pain has physical, psychological, and social implications in MS, and both comprehensive assessment and interdisciplinary management approaches are needed. We sought to develop an interdisciplinary interim guideline for the assessment and management of pain in children with MS. Methods and materials We convened a modified Delphi panel composed of 13 experts in pediatric and adult MS neurology, physiotherapy, pain, patient lived-experience, advanced practice nursing, psychology, physiatry, and MS research. A survey was sent to panelists for anonymous completion. The panel discussed survey themes extracted by the panel chair. The process was repeated twice. Results Thirteen assessment and treatment recommendations were produced regarding pain in children with MS. Discussion Future studies will assess implementation of these pain assessment and treatment guidelines in the clinical setting.
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Affiliation(s)
- Catherine Stratton
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Areti Vassilopoulos
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States
- Child Study Center, Yale School of Medicine, New Haven, CT, United States
| | - J. Nicholas Brenton
- Division of Pediatric Neurology, Department of Neurology, University of Virginia Medical Center, Charlottesville, VA, United States
| | - Kirsten Potter
- Department of Physical Therapy, Tufts University, Medford, MA, United States
| | - Wendy Vargas
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
- Department of Neurology, New York-Presbyterian NYP/Columbia University Irving Medical Center, New York, NY, United States
| | - Heather Rumm
- Connecticut Chapter, National Multiple Sclerosis Society, Hartford, CT, United States
| | - Andrea Bartels
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Mary Bailey
- Trinity Health of New England, Hartford, CT, United States
| | - Charles Odonkor
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States
- Yale New Haven Health Old Saybrook Medical Center, Old Saybrook Medical Center, New Haven, CT, United States
| | - Sharon Stoll
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
- Yale MS Center, North Haven, CT, United States
| | - E. William T. Zempsky
- Division of Pain & Palliative Medicine, Connecticut Children’s Medical Center, Hartford, CT, United States
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, United States
| | - E. Ann Yeh
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Neuroscience and Mental Health, Department of Paediatrics (Neurology), Hospital for Sick Children, SickKids Research Institute, Toronto, ON, Canada
| | - Naila Makhani
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
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11
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Suárez Bagnasco M, Paz EFV, Jerez J, Gonzalez A. Association between intelligence quotient scores and body mass index in pediatric multiple sclerosis. APPLIED NEUROPSYCHOLOGY. CHILD 2023; 12:227-234. [PMID: 35705260 DOI: 10.1080/21622965.2022.2082874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The aim of this study is to examine the relationship between body mass index (BMI) and intelligence quotient scores (IQ). The sample included 11 patients with pediatric multiple sclerosis between 8 and 17 years, mean age 14.45 years (SD = 2.69). The BMI was calculated as weight in kilograms divided by the square of height in meters. The Wechsler Intelligence Scale for Children V and the Abbreviated Weschler Intelligence Scale were used to measure total IQ. Average sample BMI and IQ were 24.61 (SD = 5.53) (range: 19-39.4) and 86.63 (SD = 14.79) (range: 66-111), respectively. Results of the Pearson correlation indicated that there was a significant negative association between BMI and IQ, (r = -0.608, p = 0.042). R-squared was 0.370. We discuss if lower IQ lead to BMI gains or whether overweight/obesity lead to intellectual functioning changes. Implication for practice and future research are presented.
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Affiliation(s)
- Mariana Suárez Bagnasco
- Department of Child Neurology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Catholic University of Uruguay, Montevideo, Uruguay
| | | | - Javier Jerez
- Department of Child Neurology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Alejandra Gonzalez
- Department of Child Neurology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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12
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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.
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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
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13
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Rahimi H, Pirmoradi M, Lavasani FF, Farahani H. The effectiveness of group intervention focused on intolerance of uncertainty on psychological distress and quality of life in multiple sclerosis patients. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:29. [PMID: 37034881 PMCID: PMC10079199 DOI: 10.4103/jehp.jehp_521_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/01/2022] [Indexed: 06/19/2023]
Abstract
AIM AND BACKGROUND Multiple sclerosis (MS) is a long-course incurable disease as well as an unknown prognosis causing patients to experience a variety of psychological outcomes. Meanwhile, inability to control the disease-related uncertainty leads to the use of maladaptive coping strategies, causing more psychological distress. This study investigated the effectiveness of intervention focused on the intolerance of uncertainty on psychological distress and quality of life in MS patients. MATERIALS AND METHODS This research adopted a true experimental design. All phases of the study were conducted online due to the COVID-19 pandemic during 2021 in Tehran. The statistical population of the study was purposefully selected from among MS patients and was randomly assigned to three groups of 20: IU intervention and two control groups (cognitive behavioral therapy (CBT) and treatment as usual (TAU) groups). The study included pre-test, post-test, and follow-up stages. The outcome measures of the study included the Depression Anxiety Stress Scale (DASS-21) as well as Multiple Sclerosis Quality of Life-54 (MSQoL-54). Mixed analysis of variance was used to analyze the data. RESULTS The results showed that IU intervention compared to CBT, is more effective on psychological distress (depression P = 0.006, anxiety P = 0.01, and stress P = 0.01) and quality of life (P = 0.001) in MS patients. Nonetheless, IU-focused intervention is more effective than TAU on psychological distress (depression P = 0.0001, anxiety P = 0.0001, stress P = 0.0001) as well as quality of life (P = 0.0001) in these patients. CONCLUSIONS IU-based intervention can reduce psychological distress and improve quality of life of MS patients. Accepting uncertainty can reduce the anxiety and stress of MS patients which can increase the quality of life of these patients.
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Affiliation(s)
- Hani Rahimi
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Pirmoradi
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Fathali Lavasani
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
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14
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Gaudioso CM, Zolno R, Wagner A, Mar S. Clinical Reasoning: A 6-Year-Old Girl With Right-Sided Pain and Weakness. Neurology 2023; 100:97-102. [PMID: 36257712 DOI: 10.1212/wnl.0000000000201481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/13/2022] [Indexed: 02/05/2023] Open
Abstract
We outline the case of a 6-year-old girl presenting with a 2-week course of waxing and waning neurologic symptoms, including right-sided pain, weakness, dizziness, and difficulty walking. Her examination was notable for right-sided weakness, hyperreflexia, and dysmetria. Diagnostic evaluation was significant for MRI with numerous T2 hyperintense, T1 hypointense, and T1-enhancing lesions located in the juxtacortical and periventricular regions, corpus callosum, brainstem, and spinal cord; positive CSF oligoclonal bands; negative serum aquaporin-4 immunoglobulin G (IgG) and myelin oligodendrocyte glycoprotein IgG; and positive serum Epstein-Barr viral capsid antigen IgG.
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Affiliation(s)
- Cristina M Gaudioso
- From the Washington University Pediatric MS, Other Demyelinating Disease Center, St. Louis, MO.
| | - Rachel Zolno
- From the Washington University Pediatric MS, Other Demyelinating Disease Center, St. Louis, MO
| | - Anne Wagner
- From the Washington University Pediatric MS, Other Demyelinating Disease Center, St. Louis, MO
| | - Soe Mar
- From the Washington University Pediatric MS, Other Demyelinating Disease Center, St. Louis, MO
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15
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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.
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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
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16
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Re-examining the characteristics of pediatric multiple sclerosis in the era of antibody-associated demyelinating syndromes. Eur J Paediatr Neurol 2022; 41:8-18. [PMID: 36137476 DOI: 10.1016/j.ejpn.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/13/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The discovery of anti-myelin oligodendrocyte glycoprotein (MOG)-IgG and anti-aquaporin 4 (AQP4)-IgG and the observation on certain patients previously diagnosed with multiple sclerosis (MS) actually have an antibody-mediated disease mandated re-evaluation of pediatric MS series. AIM To describe the characteristics of recent pediatric MS cases by age groups and compare with the cohort established before 2015. METHOD Data of pediatric MS patients diagnosed between 2015 and 2021 were collected from 44 pediatric neurology centers across Türkiye. Clinical and paraclinical features were compared between patients with disease onset before 12 years (earlier onset) and ≥12 years (later onset) as well as between our current (2015-2021) and previous (<2015) cohorts. RESULTS A total of 634 children (456 girls) were enrolled, 89 (14%) were of earlier onset. The earlier-onset group had lower female/male ratio, more frequent initial diagnosis of acute disseminated encephalomyelitis (ADEM), more frequent brainstem symptoms, longer interval between the first two attacks, less frequent spinal cord involvement on magnetic resonance imaging (MRI), and lower prevalence of cerebrospinal fluid (CSF)-restricted oligoclonal bands (OCBs). The earlier-onset group was less likely to respond to initial disease-modifying treatments. Compared to our previous cohort, the current series had fewer patients with onset <12 years, initial presentation with ADEM-like features, brainstem or cerebellar symptoms, seizures, and spinal lesions on MRI. The female/male ratio, the frequency of sensorial symptoms, and CSF-restricted OCBs were higher than reported in our previous cohort. CONCLUSION Pediatric MS starting before 12 years was less common than reported previously, likely due to exclusion of patients with antibody-mediated diseases. The results underline the importance of antibody testing and indicate pediatric MS may be a more homogeneous disorder and more similar to adult-onset MS than previously thought.
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17
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Vermersch P, Scaramozza M, Levin S, Alroughani R, Deiva K, Pozzilli C, Lyons J, Mokliatchouk O, Pultz J, N’Dure F, Liu S, Badwan R, Branco F, Hood-Humphrey V, Franchimont N, Hanna J, Maghzi AH. Effect of Dimethyl Fumarate vs Interferon β-1a in Patients With Pediatric-Onset Multiple Sclerosis: The CONNECT Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2230439. [PMID: 36169959 PMCID: PMC9520348 DOI: 10.1001/jamanetworkopen.2022.30439] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE With few approved multiple sclerosis therapies in the pediatric population, there is a need for further approved treatment options. Limited data exist for dimethyl fumarate (DMF) treatment in pediatric-onset multiple sclerosis (POMS). OBJECTIVE To compare the efficacy, safety, and tolerability of DMF vs intramuscular interferon β-1a (IFNβ-1a) in POMS. DESIGN, SETTING, AND PARTICIPANTS The CONNECT study was an active-controlled, open-label, rater-blinded 96-week randomized clinical trial in patients with POMS aged 10 to less than 18 years treated between August 2014 and November 2020. Data were analyzed from January through October 2021. INTERVENTIONS Patients were randomized to DMF or IFNβ-1a. MAIN OUTCOMES AND MEASURES The primary end point was the proportion of patients free of new or newly enlarging (N or NE) T2 hyperintense lesions at week 96 among trial completers. Secondary end points included number of N or NE T2 lesions, proportion of patients free of relapse, annualized relapse rate (ARR), and safety. The estimated proportion of participants who were relapse free up to week 96 was calculated based on the Kaplan-Meier method. Adjusted ARR was obtained from a negative binomial regression adjusted for baseline relapse rate, baseline Expanded Disability Status Scale (EDSS) score, and age group. RESULTS Among 150 patients with POMS in the intention-to-treat (ITT) population (median [range] age, 15 [10-17] years; 101 [67.3%] female patients), 78 individuals received DMF and 72 individuals received IFNβ-1a. At week 96, the proportion of patients with no N or NE T2 hyperintense lesions among 103 trial completers was 16.1% (95% CI, 8.0%-27.7%) for DMF vs 4.9% (95% CI, 0.6%-16.5%) for IFNβ-1a, and in a sensitivity analysis among the ITT population, the proportions were 10 patients receiving DMF (12.8%) vs 2 patients receiving IFNβ-1a (2.8%). The estimated proportion of patients who remained relapse free at week 96 was 66.2% for DMF vs 52.3% for IFNβ-1a. Adjusted ARR (95% CI) at week 96 was 0.24 (95% CI, 0.15-0.39) for DMF vs 0.53 (95% CI, 0.33-0.84) for IFNβ-1a; the rate ratio for DMF vs IFNβ-1a was 0.46 (95% CI, 0.26-0.80; P = .006). The number of treatment-emergent adverse events (TEAEs; 74 patients [94.9%] vs 69 patients [95.8%]), serious TEAEs (18 patients [23.1%] vs 21 patients [29.2%]), and treatment discontinuations due to TEAEs (5 patients [6.4%] vs 8 patients [11.1%]) was similar for DMF vs IFNβ-1a. CONCLUSIONS AND RELEVANCE This study found that more pediatric patients with POMS treated with DMF were free of new or newly enlarging T2 lesions and that the adjusted ARR was lower among these patients compared with those treated with interferon β-1a. DMF was well tolerated. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02283853.
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Affiliation(s)
- Patrick Vermersch
- University Lille, Inserm, Centre Hospitalier Universitaire de Lille, Fédératif Hospitalo-Universitaire Precise, Lille, France
| | | | | | | | - Kumaran Deiva
- Assistance Publique-Hôpitaux de Paris, Pediatric Neurology Department, University Hospitals Paris Saclay, Bicêtre Hospital, Le Kremlin Bicêtre, France
- French Reference Network of Rare Inflammatory Brain and Spinal Diseases, Le Kremlin Bicêtre, France
| | - Carlo Pozzilli
- Sant’ Andrea Multiple Sclerosis Center, Sapienza University, Rome, Italy
| | | | | | - Joe Pultz
- Biogen, Cambridge, Massachusetts
- Now with CR Medicon, Orange, Connecticut
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Lysenko ES, Bogdanova MD, Arsalidou M. Quantitative Meta-analyses of Cognitive Abilities in Children With Pediatric-onset Multiple Sclerosis. Neuropsychol Rev 2022; 33:459-473. [PMID: 35802297 DOI: 10.1007/s11065-022-09546-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 05/24/2022] [Indexed: 11/27/2022]
Abstract
Pediatric-onset multiple sclerosis (POMS), is the manifestation of multiple sclerosis in individuals before 18 years of age. About a third of children with POMS show some form of lower cognitive performance. The purpose of this study is to examine using quantitative meta-analyses the effect size of altered performance between children with and without POMS on overall intelligence quotient (IQ), information processing speed, and language functions. We searched the literature for studies that reported scores on cognitive tests administered to children with and without POMS. Studies were systematically reviewed using PRISMA guidelines. We analyzed data from 14 studies that examined 1283 children with and without POMS when cognitive categories consisted of five or more studies. Effect sizes, publication bias and potential confounds were considered. Significant cognitive differences are revealed for all categories with the strongest effect observed for overall IQ. A moderate effect is observed for information processing speed, and small effects for verbal fluency and verbal memory. Cognitive abilities present differently in children with POMS and a better understanding of this manifestation will inform intervention and remediation tools that can improve clinical and educational practice for the benefit of children with POMS.
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Affiliation(s)
- Elena S Lysenko
- Neurobiological Foundations of Cognitive Development - Neuropsy Lab, HSE University, 101000, Myasnitskaya st.-20, Moscow, Russian Federation
| | - Mariia D Bogdanova
- I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991, Trubetskaya st.-8/2, Moscow, Russian Federation.
- Scientific Research and Practical Center of Pediatric Psychoneurology, Michurinskiy pr.-74, 119602, Moscow, Russian Federation.
| | - Marie Arsalidou
- Neurobiological Foundations of Cognitive Development - Neuropsy Lab, HSE University, 101000, Myasnitskaya st.-20, Moscow, Russian Federation
- York University, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
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19
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Graves JS, Thomas M, Li J, Shah AR, Goodyear A, Lange MR, Schmidli H, Häring DA, Friede T, Gärtner J. Improving pediatric multiple sclerosis interventional phase III study design: a meta-analysis. Ther Adv Neurol Disord 2022; 15:17562864211070449. [PMID: 35514529 PMCID: PMC9066624 DOI: 10.1177/17562864211070449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022] Open
Abstract
Background: To support innovative trial designs in a regulatory setting for pediatric-onset multiple sclerosis (MS), the study aimed to perform a systematic literature review and meta-analysis of relapse rates with interferon β (IFN β), fingolimod, and natalizumab and thereby demonstrate potential benefits of Bayesian and non-inferiority designs in this population. Methods: We conducted a literature search in MEDLINE and EMBASE from inception until 17 June 2020 of all studies reporting annualized relapse rates (ARR) in IFN β-, fingolimod-, or natalizumab-treated patients with pediatric-onset relapsing–remitting MS. These interventions were chosen because the literature was mainly available for these treatments, and they are currently used for the treatment of pediatric MS. Two researchers independently extracted data and assessed study quality using the Cochrane Effective Practice and Organization of Care – Quality Assessment Tool. The meta-analysis estimates were obtained by Bayesian random effects model. Data were summarized as ARR point estimates and 95% credible intervals. Results: We found 19 articles, including 2 randomized controlled trials. The baseline ARR reported was between 1.4 and 3.7. The meta-analysis-based ARR was significantly higher in IFN β-treated patients (0.69, 95% credible interval: 0.51–0.91) versus fingolimod (0.11, 0.04–0.27) and natalizumab (0.17, 0.09–0.31). Based on the meta-analysis results, an appropriate non-inferiority margin versus fingolimod could be in the range of 2.29–2.67 and for natalizumab 1.72–2.29 on the ARR ratio scale. A Bayesian design, which uses historical information for a fingolimod or natalizumab control arm, could reduce the sample size of a new trial by 18 or 14 patients, respectively. Conclusion: This meta-analysis provides evidence that relapse rates are considerably higher with IFNs versus fingolimod or natalizumab. The results support the use of innovative Bayesian or non-inferiority designs to avoid exposing patients to less effective comparators in trials and bringing new medications to patients more efficiently.
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Affiliation(s)
- Jennifer S. Graves
- Department of Neurosciences, University of California, San Diego, Box 0662 ACTRI, 9452 Medical Center Drive, Suite 4W-222, San Diego, CA 92037, USA
| | | | - Jun Li
- Novartis Pharma AG, Basel, Switzerland
| | | | - Alexandra Goodyear
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA at the time of article development
| | | | | | | | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Jutta Gärtner
- Department of Pediatrics and Adolescent Medicine, German Center for Multiple Sclerosis in Childhood and Adolescence, University Medical Center Göttingen, Göttingen, Germany
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20
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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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21
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Krupp L, Banwell B, Chitnis T, Deiva K, Gaertner J, Ghezzi A, Huppke P, Waubant E, DeLasHeras V, Azmon A, Karan R. Effect of fingolimod on health-related quality of life in paediatric patients with multiple sclerosis: results from the phase 3 PARADIG MS Study. BMJ Neurol Open 2022; 4:e000215. [PMID: 35308898 PMCID: PMC8883212 DOI: 10.1136/bmjno-2021-000215] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/11/2022] [Indexed: 11/20/2022] Open
Abstract
Background In the PARADIGMS Study, fingolimod demonstrated superior efficacy versus interferon (IFN) β-1a and comparable overall incidence of adverse events but slightly higher rate of serious adverse events in patients with paediatric-onset multiple sclerosis (PoMS). Here, we report the health-related quality of life (HRQoL) outcomes from PARADIGMS. Methods Patients with PoMS (N=215; aged 10-<18 years) were randomised to once-daily oral fingolimod (N=107) or once-weekly intramuscular IFN β-1a (N=108). HRQoL outcomes were assessed using the 23-item Pediatric Quality of Life (PedsQL) scale that comprises Physical and Psychosocial Health Summary Scores (including Emotional, Social and School Functioning). A post hoc inferential analysis evaluated changes in self-reported or parent-reported PedsQL scores from baseline up to 2 years between treatment groups using an analysis of covariance model. Results Treatment with fingolimod showed improvements versus IFN β-1a on the PedsQL scale in both the self-reported and parent-reported Total Scale Scores (4.66 vs -1.16, p≤0.001 and 2.71 vs -1.02, p≤0.05, respectively). The proportion of patients achieving a clinically meaningful improvement in the PedsQL Total Scale Score was two times higher with fingolimod versus IFN β-1a per the self-reported scores (47.5% vs 24.2%, p=0.001), and fingolimod was favoured versus IFN β-1a per the parent-reported scores (37.8% vs 24.7%, p=non-significant). Group differences in self-reported Total Scale Scores in favour of fingolimod were most pronounced among patients who had ≥2 relapses in the year prior to study entry or who showed improving or stable Expanded Disability Status Scale scores during the study. Conclusion Fingolimod improved HRQoL compared with IFN β-1a in patients with PoMS as evidenced by the self-reported and parent-reported PedsQL scores.
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Affiliation(s)
- Lauren Krupp
- Pediatric MS Center, NYU Langone Health, New York, New York, USA
| | - Brenda Banwell
- The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tanuja Chitnis
- Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kumaran Deiva
- Department of Pediatric Neurology, French National Reference Center for Rare inflammatory and Auto-Immune Brain and Spinal Diseases, University Hospitals Paris Saclay, Bicêtre Hospital, Le Kremlin Bicêtre, Paris, France
| | - Jutta Gaertner
- Department of Pediatrics and Adolescent Medicine, German Centre for Multiple Sclerosis in Childhood and Adolescence University Medical Centre, Göttingen, Germany
| | - Angelo Ghezzi
- Centro Studi Sclerosi Multipla, Ospedale di Gallarate, Gallarate, Italy
| | - Peter Huppke
- Department of Pediatrics and Adolescent Medicine, German Centre for Multiple Sclerosis in Childhood and Adolescence University Medical Centre, Göttingen, Germany
- Department of Neuropediatrics, Jena University Hospital, Jena, Germany
| | - Emmanuelle Waubant
- Department of Neurology, University of California, San Francisco, California, USA
| | | | - Amin Azmon
- Biostatistics, Novartis Pharma AG, Basel, Switzerland
| | - Rajesh Karan
- Global Drug Delivery, Novartis Pharma AG, Basel, Switzerland
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22
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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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23
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Treatment of multiple sclerosis in children: A brief overview. Clin Immunol 2022; 237:108947. [PMID: 35123059 DOI: 10.1016/j.clim.2022.108947] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/29/2021] [Accepted: 01/31/2022] [Indexed: 11/20/2022]
Abstract
Multiple sclerosis (MS) is the most common autoimmune, chronic inflammatory demyelinating disorder of the central nervous system. Pediatric-onset MS (POMS), as opposed to adult-onset MS (AOMS), is a rare condition, presenting similar clinical features to AOMS, but a more active course of the disease, with higher relapse rates and greater white and grey matter damage. To date, the therapeutic approaches to treat POMS have been extrapolated from observational studies and data from trials conducted on adults, raising concerns about their efficacy and safety in the pediatric population. Herein, we discuss the most common therapeutic strategies used in POMS management, basing on the individual clinical practice and experience.
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24
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Jakimovski D, Awan S, Eckert SP, Farooq O, Weinstock-Guttman B. Multiple Sclerosis in Children: Differential Diagnosis, Prognosis, and Disease-Modifying Treatment. CNS Drugs 2022; 36:45-59. [PMID: 34940954 PMCID: PMC8697541 DOI: 10.1007/s40263-021-00887-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 12/19/2022]
Abstract
Pediatric-onset multiple sclerosis (POMS) is a rare neuroinflammatory and neurodegenerative disease that has a significant impact on long-term physical and cognitive patient outcomes. A small percentage of multiple sclerosis (MS) diagnoses occur before the age of 18 years. Before treatment initiation, a careful differential diagnosis and exclusion of other similar acquired demyelinating syndromes such as anti-aquaporin-4-associated neuromyelitis optica spectrum disorder (AQP4-NMOSD) and myelin oligodendrocyte glycoprotein antibody spectrum disorder (MOGSD) is warranted. The recent 2017 changes to the McDonald criteria can successfully predict up to 71% of MS diagnoses and have good specificity of 95% and sensitivity of 71%. Additional measures such as the presence of T1-weighted hypointense lesions and/or contrast-enhancing lesions significantly increase the accuracy of diagnosis. In adults, early use of disease-modifying therapies (DMTs) is instrumental to a better long-term prognosis, including lower rates of relapse and disability worsening, and numerous FDA-approved therapies for adult-onset MS are available. However, unlike their adult counterparts, the development, testing, and regulatory approval of POMS treatments have been significantly slower and hindered by logistic and/or ethical considerations. Currently, only two MS DMTs (fingolimod and teriflunomide) have been tested in large phase III trials and approved by regulatory agencies for use in POMS. First-line therapies not approved by the FDA for use in children (interferon-β and glatiramer acetate) are also commonly used and result in a significant reduction in inflammatory activity when compared with non-treated POMS patients. An increasing number of POMS patients are now treated with moderate efficacy therapies such as dimethyl fumarate and high-efficacy therapies such as natalizumab, anti-CD20 monoclonal antibodies, anti-CD52 monoclonal antibodies, and/or autologous hematopoietic stem cell transplantation. These high-efficacy DMTs generally provide additional reduction in inflammatory activity when compared with the first-line medications (up to 62% of relapse-rate reduction). Therefore, a number of phase II and III trials are currently investigating their efficacy and safety in POMS patients. In this review, we discuss potential changes in the regulatory approval process for POMS patients that are recommended for DMTs already approved for the adult MS population, including smaller sample size for pharmacokinetic/pharmacodynamic studies, MRI-centered primary outcomes, and/or inclusion of teenagers in the adult trials.
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Affiliation(s)
- Dejan Jakimovski
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Science, University of Buffalo, 1010 Main Street, Buffalo, NY 14202 USA ,Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY USA
| | - Samreen Awan
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Science, University of Buffalo, 1010 Main Street, Buffalo, NY 14202 USA
| | - Svetlana P. Eckert
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Science, University of Buffalo, 1010 Main Street, Buffalo, NY 14202 USA
| | - Osman Farooq
- Division of Pediatric Neurology, Oishei Children’s Hospital of Buffalo, Buffalo, NY USA ,Department of Neurology, Jacobs School of Medicine, State University of New York at Buffalo, Buffalo, NY USA
| | - Bianca Weinstock-Guttman
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Science, University of Buffalo, 1010 Main Street, Buffalo, NY, 14202, USA.
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25
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Brola W, Steinborn B, Niewada M, Mazurkiewicz-Bełdzińska M, Jóźwiak S, Sobolewski P, Żak M, 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, Chorąży M, Kułakowska A, Ujma-Czapska B, Przysło Ł, Połatyńska K, Dudzińska M, Mitosek-Szewczyk K, Melnyk A, Knap M, Kotulska K. Pediatric-onset multiple sclerosis in Poland: A registry-based retrospective cohort study. Mult Scler Relat Disord 2022; 57:103344. [DOI: 10.1016/j.msard.2021.103344] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/14/2021] [Accepted: 10/21/2021] [Indexed: 11/28/2022]
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Nasehi MM, Nikkhah A, Moosazadeh M, Saket S, Alizadeh Navaei R. Incidence of Pediatric Multiple Sclerosis in Iran within 2000-2019. IRANIAN JOURNAL OF CHILD NEUROLOGY 2022; 16:31-38. [PMID: 35222655 PMCID: PMC8753005 DOI: 10.22037/ijcn.v16i1.35572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/15/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Due to a lack of data on pediatric multiple sclerosis (MS) epidemiology in Iran, this study aimed to determine the incidence rate of pediatric MS in Iran. MATERIALS & METHODS All the data of the patients with MS registered in the Ministry of Health and Medical Education of Iran for 20 years were collected in this study; those born in 1982 and diagnosed with the disease and treated since 2000 were included in this study. Therefor The collected variables were patients' age at the time of diagnosis, gender, year of diagnosis, urban or rural residency, and province of residence. Additionally, age-specific incidence rates per 100,000 of the population were calculated. RESULTS This study was performed on 4544 cases of pediatric MS within 2000-2019, of which 997 patients (21.9%) were male. The mean age of the patients with MS at the time of diagnosis was 14.3±4.6 years, and 4414 children (97.1%) lived in urban areas. The incidence rate of pediatric MS in Iran during 20 years increased from 0.26 per 100,000 of the population in 2000 to 1.53 in 2019. CONCLUSION The incidence of pediatric MS in Iran is high, and the development of diagnostic practices in the past decade in Iran has contributed to the detection of this high incidence.
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Affiliation(s)
- Mohammad Mahdi Nasehi
- Pediatric Neurology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Pediatric Neurology Department, Mofid Children's Hospital, Faculty of Medicine, ShahidBeheshti University of Medical Sciences, Tehran, Iran
| | - Ali Nikkhah
- Pediatric Neurology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Pediatric Neurology Department, Mofid Children's Hospital, Faculty of Medicine, ShahidBeheshti University of Medical Sciences, Tehran, Iran
| | - Mahmood Moosazadeh
- Epidemiology and Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sasan Saket
- Assistant Professor of Pediatric Neurology, Department of Pediatric Neurology, School of Medicine, Pediatric Neurology Research Center, Shohada-e-Tajrish Hospital, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Alizadeh Navaei
- Epidemiology and Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
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Pilotto S, Gencarelli J, Bova S, Gerosa L, Baroncini D, Olivotto S, Alfei E, Zaffaroni M, Suppiej A, Cocco E, Trojano M, Amato MP, D'Alfonso S, Martinelli-Boneschi F, Waubant E, Ghezzi A, Bergamaschi R, Pugliatti M. Etiological research in pediatric multiple sclerosis: A tool to assess environmental exposures (PEDiatric Italian Genetic and enviRonment ExposurE Questionnaire). Mult Scler J Exp Transl Clin 2021; 7:20552173211059048. [PMID: 34868629 PMCID: PMC8640303 DOI: 10.1177/20552173211059048] [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: 06/18/2021] [Accepted: 10/22/2021] [Indexed: 11/16/2022] Open
Abstract
Background The etiology of pediatric-onset multiple sclerosis is unknown although putative genetic and environmental factors appear to be involved. Among children multiple sclerosis onset occurs closer to the susceptibility window thank in adults and the exposure to etiological environmental factors is more informative. An Italian multicentre case-control study (the PEDiatric Italian Genetic and enviRonment ExposurE, PEDIGREE study) was designed to investigate environmental exposures in pediatric-onset multiple sclerosis and their interaction with genetics. Objectives To collect evidence on exposures to environmental risk factors in pediatric-onset multiple sclerosis, a questionnaire was developed for the Italian population (PEDIGREE Questionnaire) and is presented. Methods PEDIGREE Questionnaire develops from an existing tool used in case-control studies on pediatric-onset multiple sclerosis in US Americans, and was translated, adapted and tested for the contents perceived relevance, acceptability, feasibility and reliability in a population of Italian pediatric subjects and their parents recruited from clinics and general population. Results PEDIGREE Questionnaire contents were overall deemed relevant by the study population, acceptable for 100% participants and feasible for at least 98%. PEDIGREE Questionnaire degree of reliability ranged 56% to 72%. Conclusion PEDIGREE Questionnaire proves to be an efficient tool to assess environmental exposures in the Italian pediatric population. We encourage the dissemination of population-specific questionnaires and shared methodology to optimize efforts in MS etiological research.
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Affiliation(s)
- Silvy Pilotto
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Jessica Gencarelli
- Department of Medical Sciences - Pediatric Section, University of Ferrara, Ferrara, Italy
| | - Stefania Bova
- Pediatric Neurology Unit, V. Buzzi Children's Hospital, Milan, Italy
| | - Leonardo Gerosa
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | | | | | - Enrico Alfei
- Pediatric Neurology Unit, V. Buzzi Children's Hospital, Milan, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Centre, ASST Valle Olona, Gallarate, Italy
| | - Agnese Suppiej
- Department of Medical Sciences - Pediatric Section, University of Ferrara, Ferrara, Italy
| | - Eleonora Cocco
- Department Medical Science and Public Health, University of Cagliari, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Italy
| | | | | | | | - Emmanuelle Waubant
- Department of Neurology, UC San Francisco, San Francisco, California, USA
| | - Angelo Ghezzi
- Multiple Sclerosis Centre, ASST Valle Olona, Gallarate, Italy
| | | | - Maura Pugliatti
- Department of Neuroscience and Rehabilitation, Interdepartmental Research Center for the Study of Multiple Sclerosis and Inflammatory and Degenerative Diseases of the Nervous System, University of Ferrara, Ferrara, Italy
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Prevalence of Pediatric Onset Multiple Sclerosis in Saudi Arabia. Mult Scler Int 2021; 2021:4226141. [PMID: 34796030 PMCID: PMC8595009 DOI: 10.1155/2021/4226141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background The prevalence of multiple sclerosis (MS) appears to be increasing worldwide. However, data on the pediatric onset of MS is lacking, particularly in developing countries. Objective This study is aimed at reporting the current burden of the pediatric onset of MS in the five regions of Saudi Arabia. Methods This study used relevant data from the National Saudi MS Registry that was operational between 2015 and 2018. The data on patients with pediatric onset MS from all the hospitals included in the registry was retrospectively analyzed using the age of diagnosis. Patients who were 1-18 years old when diagnosed were included in the analysis. Results The registry included 287 patients with pediatric onset MS, with a mean age of diagnosis at 15.7 (SD: 2.06). 74.2% of the participants were females. For the included hospitals, the estimated prevalence of pediatric MS was at 2.73/100,000 pediatric Saudi population. The prevalence of pediatric MS in the remaining nonparticipant hospitals was then projected taking into account both the size of pediatric population in the Kingdom per region and the number of facilities treating and managing MS in each of the corresponding regions. The overall projected prevalence was found to be 14.33/100,000 Saudi pediatric population. Conclusion To the best of our knowledge, this study reported the latest epidemiological data of pediatric onset of MS in Saudi Arabia. The current prevalence of MS among the pediatric Saudi population was found to be 2.73/100,000, and the overall projected prevalence was estimated at 14.33/100,000. Our findings were similar to those in other pediatric MS cohorts. Further studies are needed to understand the long-term prognosis, response to treatment, and disease course.
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Steinberg DJ, Aqeilan RI. WWOX-Related Neurodevelopmental Disorders: Models and Future Perspectives. Cells 2021; 10:cells10113082. [PMID: 34831305 PMCID: PMC8623516 DOI: 10.3390/cells10113082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/28/2021] [Accepted: 11/03/2021] [Indexed: 12/12/2022] Open
Abstract
The WW domain-containing oxidoreductase (WWOX) gene was originally discovered as a putative tumor suppressor spanning the common fragile site FRA16D, but as time has progressed the extent of its pleiotropic function has become apparent. At present, WWOX is a major source of interest in the context of neurological disorders, and more specifically developmental and epileptic encephalopathies (DEEs). This review article aims to introduce the many model systems used through the years to study its function and roles in neuropathies. Similarities and fundamental differences between rodent and human models are discussed. Finally, future perspectives and promising research avenues are suggested.
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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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Milles P, De Filippo G, Maurey H, Tully T, Deiva K. Obesity in Pediatric-Onset Multiple Sclerosis: A French Cohort Study. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/5/e1044. [PMID: 34285094 PMCID: PMC8293287 DOI: 10.1212/nxi.0000000000001044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/26/2021] [Indexed: 01/03/2023]
Abstract
Objective To study the link between a high body mass index (BMI) in childhood and the occurrence of pediatric-onset multiple sclerosis (POMS) and to compare, within the MS population, the clinical-radiologic-biological characteristics, according to BMI. Methods A case-control study comparing BMI data of 60 patients with POMS (39 girls and 21 boys) at Bicêtre Hospital with that of 113 non-neurologic controls NNCs (68 girls and 45 boys) and 18,614 healthy controls HCs (9,271 girls and 9,343 boys) was performed. Crude BMI (cBMI), residual BMI (rBMI = measured BMI − expected BMI for age), z-score (rBMI/SD), and adult equivalent categories (International Obesity Task Force ≥25 = overweight, ≥30 = obese) were assessed. Results In boys, cBMI and rBMI were significantly higher in patients with POMS compared with NNCs (cBMI: +2.9; rBMI: +2.95, p < 0.01) and HCs (cBMI: +2.04, p < 0.01). In girls, cBMI or rBMI did not differ between POMS and NNCs patients (cBMI p = 0.4; rBMI p = 0.44) but with HCs (cBMI +0.99, p < 0.01). CSF inflammatory markers increased with BMI in prepubertal patients (p < 0.01), whereas vitamin D level at diagnosis was lower in boys with higher BMI (p = 0.016). Increased BMI was not associated with clinical and radiologic disease characteristics. Conclusions Overweight and obesity are more frequently observed at diagnosis, particularly in boys with POMS compared with non-neurologic controls and French HCs. Moreover, BMI is related to initial inflammation in the CSF in prepubertal patients with POMS suggesting an interaction between excess body fat, sexual hormones, and POMS occurrence.
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Affiliation(s)
- Pauline Milles
- From the Assistance Publique-Hôpitaux de Paris (P.M., H.M., K.D.), Hôpitaux Universitaires Paris Saclay, Hôpital Bicêtre, Pediatric Neurology Department, National Reference Center for Rare Inflammatory Brain and Spinal Diseases, Le Kremlin-Bicêtre; Assistance Publique-Hôpitaux de Paris (G.D.F.), Hôpital Robert Debré, Pediatric Endocrinology Department, French Clinical Research Group in Adolescent Medicine and Health, Paris; and Sorbonne Université (T.T.), CNRS, IRD, INRA, Institute of Ecology and Environmental Sciences, iEES Paris, UMR7618, France.
| | - Gianpaolo De Filippo
- From the Assistance Publique-Hôpitaux de Paris (P.M., H.M., K.D.), Hôpitaux Universitaires Paris Saclay, Hôpital Bicêtre, Pediatric Neurology Department, National Reference Center for Rare Inflammatory Brain and Spinal Diseases, Le Kremlin-Bicêtre; Assistance Publique-Hôpitaux de Paris (G.D.F.), Hôpital Robert Debré, Pediatric Endocrinology Department, French Clinical Research Group in Adolescent Medicine and Health, Paris; and Sorbonne Université (T.T.), CNRS, IRD, INRA, Institute of Ecology and Environmental Sciences, iEES Paris, UMR7618, France
| | - Hélène Maurey
- From the Assistance Publique-Hôpitaux de Paris (P.M., H.M., K.D.), Hôpitaux Universitaires Paris Saclay, Hôpital Bicêtre, Pediatric Neurology Department, National Reference Center for Rare Inflammatory Brain and Spinal Diseases, Le Kremlin-Bicêtre; Assistance Publique-Hôpitaux de Paris (G.D.F.), Hôpital Robert Debré, Pediatric Endocrinology Department, French Clinical Research Group in Adolescent Medicine and Health, Paris; and Sorbonne Université (T.T.), CNRS, IRD, INRA, Institute of Ecology and Environmental Sciences, iEES Paris, UMR7618, France
| | - Thomas Tully
- From the Assistance Publique-Hôpitaux de Paris (P.M., H.M., K.D.), Hôpitaux Universitaires Paris Saclay, Hôpital Bicêtre, Pediatric Neurology Department, National Reference Center for Rare Inflammatory Brain and Spinal Diseases, Le Kremlin-Bicêtre; Assistance Publique-Hôpitaux de Paris (G.D.F.), Hôpital Robert Debré, Pediatric Endocrinology Department, French Clinical Research Group in Adolescent Medicine and Health, Paris; and Sorbonne Université (T.T.), CNRS, IRD, INRA, Institute of Ecology and Environmental Sciences, iEES Paris, UMR7618, France
| | - Kumaran Deiva
- From the Assistance Publique-Hôpitaux de Paris (P.M., H.M., K.D.), Hôpitaux Universitaires Paris Saclay, Hôpital Bicêtre, Pediatric Neurology Department, National Reference Center for Rare Inflammatory Brain and Spinal Diseases, Le Kremlin-Bicêtre; Assistance Publique-Hôpitaux de Paris (G.D.F.), Hôpital Robert Debré, Pediatric Endocrinology Department, French Clinical Research Group in Adolescent Medicine and Health, Paris; and Sorbonne Université (T.T.), CNRS, IRD, INRA, Institute of Ecology and Environmental Sciences, iEES Paris, UMR7618, France
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Ghai S, Kasilingam E, Lanzillo R, Malenica M, van Pesch V, Burke NC, Carotenuto A, Maguire R. Needs and Experiences of Children and Adolescents with Pediatric Multiple Sclerosis and Their Caregivers: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2021; 8:445. [PMID: 34070298 PMCID: PMC8226634 DOI: 10.3390/children8060445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/19/2021] [Accepted: 05/23/2021] [Indexed: 01/21/2023]
Abstract
In the present study we conduct a systematic review to evaluate the needs and experience of people with pediatric multiple sclerosis (MS) and their caregivers. The literature search was conducted across 10 academic databases, adhering to PRISMA-P guidelines. Quality appraisal was conducted using the mixed method appraisal test for individual studies, and GRADE-CERQual to establish overall confidence of findings. Results were analyzed using a process of narrative synthesis. We identified 26 studies which included 2253 children/adolescents with MS (CAMS) and 1608 caregivers. MS was reported to negatively impact experiences for CAMS in domains such as of school performance, social relationships, mental health, and overall physical functioning. Specifically, fatigue and social support were reported as the most important barriers and facilitators for CAMS, respectively. In terms of caregiver experience, negative impacts were reported on social functioning, mental health, and quality of life. Additionally, lack of awareness concerning MS was one of the biggest challenges reported. Caregivers expressed needs for psychological and social support. This study provides the first evidence regarding the needs and experiences of CAMS and their caregivers. Findings can be used to address policy gaps for supporting families affected by pediatric MS.
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Affiliation(s)
- Shashank Ghai
- School of Physical and Occupational Therapy, McGill University, Montréal, QC H3G 1Y5, Canada
- Feil & Oberfeld Research Centre of the Jewish Rehabilitation Hospital—CISSS Laval, a Research Site of the Centre for Interdisciplinary Research of Greater Montreal (CRIR), Laval, QC H7V 1R2, Canada
- Department of Family Medicine, McGill University, Montréal, QC GRM MDI, Canada
| | | | - Roberta Lanzillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, 80138 Naples, Italy; (R.L.); (A.C.)
| | - Masa Malenica
- Department of Child Neurology, Associated Member of the ERN EpiCARE, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia;
| | - Vincent van Pesch
- Department of Neurology, Cliniques Universitaires Saint-Luc, UCLouvain, 1200 Brussels, Belgium;
| | - Niamh Caitlin Burke
- Department of Psychology, Maynooth University, Maynooth W23 F2K8, Ireland; (N.C.B.); (R.M.)
| | - Antonio Carotenuto
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, 80138 Naples, Italy; (R.L.); (A.C.)
| | - Rebecca Maguire
- Department of Psychology, Maynooth University, Maynooth W23 F2K8, Ireland; (N.C.B.); (R.M.)
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Ertugrul G, Aksoy S, Konuskan B, Eskandarian L, Oguz KK, Anlar B. Impairment of vestibulo-collic reflex and linear vestibulo-ocular reflex in pediatric-onset multiple sclerosis patients. Clin Neurophysiol 2021; 132:1813-1819. [PMID: 34130249 DOI: 10.1016/j.clinph.2021.04.014] [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: 09/01/2020] [Revised: 02/11/2021] [Accepted: 04/05/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study aimed to examine the vestibulo-collic reflex (VCR) and linear vestibulo-ocular reflex (lVOR) and their correlation with brain lesions in pediatric-onset multiple sclerosis (POMS). METHODS The study group consisted of 17 patients (34 ears) with POMS (mean age 18.73 ± 2.02, mean age at disease onset 14.64 ± 1.36 years), and the control group included 11 age-matched healthy subjects (22 ears). Ocular and cervical Vestibular Evoked Myogenic Potentials (oVEMP and cVEMP) were performed to assess IVOR and VCR pathways. Magnetic Resonance Imaging was evaluated in the study group. RESULTS In the POMS group, 47.05 % of oVEMPs and 17.64 % of the cVEMPs were abnormal, while all VEMPs were normal in the control group. The oVEMP amplitude was associated with infratentorial lesion volume (r = -0.459, p = 0.01) and total lesion volume of the brainstem and cerebellum (r = -0.450, p = 0.01). The cVEMP asymmetry ratio was correlated with the deep white matter lesion volume (r = 0.683, p < 0.001). The MVEMP scores were found to correlate only with lesion volumes in the cerebellum (r = 0.488, p = 0.04) and infratentorial region (r = 0.573, p = 0.01). CONCLUSIONS Ocular and cervical VEMP abnormalities confirm that lVOR and VCR pathways may be affected in early POMS. SIGNIFICANCE Routine use of the VEMP test, especially the oVEMP test is recommended as a useful tool in the follow-up of POMS patients.
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Affiliation(s)
- Gorkem Ertugrul
- Hacettepe University, Faculty of Health Sciences, Department of Audiology, Ankara, Turkey.
| | - Songul Aksoy
- Hacettepe University, Faculty of Health Sciences, Department of Audiology, Ankara, Turkey; Hacettepe University, Dizziness and Balance Disorders Research and Application Center, Ankara, Turkey
| | - Bahadır Konuskan
- Hacettepe University, Faculty of Medicine, Department of Pediatric Neurology, Ankara, Turkey
| | - Laleh Eskandarian
- Bilkent University National Magnetic Resonance Research Center, Ankara, Turkey
| | - Kader Karli Oguz
- Bilkent University National Magnetic Resonance Research Center, Ankara, Turkey; Hacettepe University, Faculty of Medicine, Department of Radiology, Ankara, Turkey
| | - Banu Anlar
- Hacettepe University, Faculty of Medicine, Department of Pediatric Neurology, Ankara, Turkey
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Palavra F, Figueiroa S, Correia AS, Tapadinhas F, Cerqueira J, Guerreiro RP, de Sá J, Sá MJ, Almeida S, Mota P, Sousa L. TyPed study: Natalizumab for the treatment of pediatric-onset multiple sclerosis in Portugal. Mult Scler Relat Disord 2021; 51:102865. [PMID: 33714125 DOI: 10.1016/j.msard.2021.102865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/08/2021] [Accepted: 02/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND A significant proportion of pediatric-onset multiple sclerosis (POMS) patients do not respond to first-line disease-modifying therapies. Clinical trials showed that natalizumab is effective and safe in adults, but there are limited clinical trial data for children. Natalizumab is currently prescribed off-label for POMS. We aimed to characterize the effectiveness, safety and tolerability of natalizumab in all POMS cases treated in Portugal (from 2007 to 2018). METHODS Data from clinical records were retrospectively collected for all POMS cases treated with natalizumab in Portugal. RESULTS Twenty-one patients were included, 14 (67%) of which were female. The median age at POMS diagnosis was 13 years old. The median duration of treatment with natalizumab was 2 years and 3 months. Median Expanded Disability Status Scale score decreased from 1.5 to 1.0 after 24 months. The Annualized Relapse Rate decreased from 1.31 events/patient/year before treatment with natalizumab to 0 after 12 months of treatment and to 0.04 after 24 months. No gadolinium-enhancing lesions or new or enlarged T2 hyperintense lesions were observed in 8/8 patients (100%) after 12 months, and 4/5 (80%) after 24 months. There was one possible serious adverse event, which did not require dose adjustment. Five patients discontinued treatment due to positive anti-JCV (JC virus) antibody JC serostatus. CONCLUSION Natalizumab may be an effective and safe disease-modifying therapy for POMS. Our results are in line with data published for the adult population, as well as with similar observational studies in pediatric populations in other regions.
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Affiliation(s)
- Filipe Palavra
- Centre for Child Development - Neuropediatrics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra; Laboratory of Pharmacology and Experimental Therapeutics, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - Sónia Figueiroa
- Neuropediatrics Unit, Centro Materno-Infantil do Norte, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Ana Sofia Correia
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental; CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Fernando Tapadinhas
- Department of Pediatrics, Hospital de Faro, Centro Hospitalar e Universitário do Algarve, Faro, Portugal
| | - João Cerqueira
- Department of Neurology, Hospital de Braga; 2CA - Clinical Academic Centre Braga; School of Medicine, University of Minho, Braga, Portugal
| | - Rui Pedro Guerreiro
- Department of Neurology, Hospital de São Bernardo, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - João de Sá
- Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Maria José Sá
- Department of Neurology, Centro Hospitalar e Universitário de São João; Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal
| | | | | | - Lívia Sousa
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Naseri A, Nasiri E, Sahraian MA, Daneshvar S, Talebi M. Clinical Features of Late-Onset Multiple Sclerosis: a Systematic Review and Meta-analysis. Mult Scler Relat Disord 2021; 50:102816. [PMID: 33571792 DOI: 10.1016/j.msard.2021.102816] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) commonly affects young adults at the ages 20 to 40 years old, but it can onset at each age. Late-onset multiple sclerosis (LOMS) is defined as symptoms initiating after the age of 50. Misdiagnosis and a remarkable gap in diagnosis of LOMS is a challenge of the elderly population so in this article we described the proportion of LOMS and the clinical features and phenotype of the disease in this age group. METHODS After registration of the study protocol, an electronic search was performed in 3 databases and for full coverage of the published studies, we also checked the references of each related article. Two independent researchers screened the records in title/abstract and full-text stages and extracted the data using a data extraction table. The risk of bias was assessed using Joanna Briggs Institute checklist and meta-analysis was conducted by CMA 2. Only the studies with 50 years old cut-off and using McDonald or Poser diagnostic criteria were included in the meta-analysis. RESULTS After removing duplicated studies, out of 733 results of electronic and hand searching, 31 studies met our inclusion criteria for the systematic review, and 11 of them were included in the quantitative synthesis. With different cut-offs and diagnostic methods 1.1% to 21.3% proportion of LOMS, has been reported in the studies. Meta-analysis reached a 5.01% (95% CI: 3.78% to 6.57%), proportion of LOMS in total MS cases. The female cases were more than males (range between 57.7% to 70.2%) and 64.46% (95% CI: 61.94% to 66.91%) proportion of females has been found in this study. 65.00% (95% CI: 44.71% to 81.02%) proportion of spinal cord involvements and 49.80% (95% CI: 39.28% to 60.24%) proportion of relapsing-remitting multiple sclerosis (RRMS) was also observed in LOMS cases. In 4 of included studies, the progressive form was the predominant phenotype. The most prevalent first disease presentation of LOMS was motor dysfunction (ranges between 100% to 35.4%) followed by sensory problems (ranges between 94% to 5%), visual symptoms (ranges between 22.9% to 5%), and brainstem dysfunction (ranges between 25% to 12.3%). The proportion of positive oligoclonal band (OCB), was varied from 46% to 98% in different studies and positive immunoglobulin G (IgG) index also was seen in 45.04% and 66% of the patients. 2.2% - 12.5% of the LOMS cases had a positive family history. CONCLUSION In about 5% of cases, MS can be diagnosed at ages above 50 years old. There is an increasing concern of a more progressive form of MS in LOMS cases. Unlike the adult-onset MS, the first presentation of LOMS is usually motor dysfunction. Understanding the proportion and clinical features of LOMS will help clinicians with the diagnosis of MS in this age group and prevention of wrong management plans and complications in these patients. Although the proportion of females is still more than males in LOMS cases; but there is a trend to increase in male cases with aging.
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Affiliation(s)
- Amirreza Naseri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran; Research Center for Evidence Based Medicine, Iranian EBM Centre, a Joanna Briggs Institute Affiliated Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Ehsan Nasiri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran; Research Center for Evidence Based Medicine, Iranian EBM Centre, a Joanna Briggs Institute Affiliated Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mohammad Ali Sahraian
- Sina MS Research Center, Sina hospital, and department of neurology, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sara Daneshvar
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mahnaz Talebi
- Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran.
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Yoon HH, Park JY, Kim SY, Lee NM, Yi DY, Yun SW, Lim IS, Chae SA. Epidemiology of Demyelinating Diseases in Korean Pediatric Patients. J Child Neurol 2021; 36:141-147. [PMID: 32988277 DOI: 10.1177/0883073820959543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The epidemiology of demyelinating diseases in the Korean pediatric population has not been reported to date. This study aimed to identify the epidemiology of demyelinating diseases in Korean children by using big data. The subjects were children (0-17 years old) diagnosed with acute-disseminated encephalomyelitis, multiple sclerosis, neuromyelitis optica, and Guillain-Barré syndrome enrolled in the Korean Health Insurance Review and Assessment Service (HIRA) from January 2010 to December 2017.Of 1722 enrolled children, 553 (32.1%) had acute-disseminated encephalomyelitis, 170 (9.9%) had multiple sclerosis, 68 (3.9%) had neuromyelitis optica, and 931 (54.1%) had Guillain-Barré syndrome. The male-female ratios were 1.47:1 in acute-disseminated encephalomyelitis, 1.43:1 in Guillain-Barré syndrome, 1:1.66 in multiple sclerosis, and 1:1.62 in neuromyelitis optica. Demyelinating diseases were most prevalent in summer. The prevalence differed by region, with 545 (31.6%) in Seoul and 298 (17.3%) in Gyeonggi. This study is the first to identify the incidence of demyelinating diseases in South Korea.
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Affiliation(s)
- Hye Hyun Yoon
- Department of Pediatrics, 65542Chung-Ang University Hospital, Seoul, Korea
| | - Ji Young Park
- Department of Pediatrics, 65542Chung-Ang University Hospital, Seoul, Korea
| | - Su Yeong Kim
- Department of Pediatrics, 65542Chung-Ang University Hospital, Seoul, Korea
| | - Na Mi Lee
- Department of Pediatrics, 65542Chung-Ang University Hospital, Seoul, Korea
| | - Dae Yong Yi
- Department of Pediatrics, 65542Chung-Ang University Hospital, Seoul, Korea
| | - Sin Weon Yun
- Department of Pediatrics, 65542Chung-Ang University Hospital, Seoul, Korea
| | - In Seok Lim
- Department of Pediatrics, 65542Chung-Ang University Hospital, Seoul, Korea
| | - Soo Ahn Chae
- Department of Pediatrics, 65542Chung-Ang University Hospital, Seoul, Korea
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Characteristics of pediatric multiple sclerosis: A tertiary referral center study. PLoS One 2020; 15:e0243031. [PMID: 33264341 PMCID: PMC7710048 DOI: 10.1371/journal.pone.0243031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 11/16/2020] [Indexed: 11/19/2022] Open
Abstract
Objective The present study represents one of the largest series of pediatric multiple sclerosis (PedMS) in Western Balkan region. This is the first study aimed to evaluate the characteristics of PedMS in the Serbian population. Methods This retrospective study on 54 PedMS, aged 7–17 years, was performed at the Clinic of Neurology and Psychiatry for Children and Youth in Belgrade, Serbia, a tertiary center for the diagnosis and treatment of children with neurological and psychiatric diseases. Results Female to male ratio was 37 (68.5%): 17 (31.5%). Family history of MS was noted in 9.3% and autoimmune diseases in 24.1% patients. Co-occurring migraine was in 7,4%. Monofocal onset of disease was present in 77.8% patients. The most common initial symptoms were optic neuritis (37%), sensory disturbances (31.5%), motor deficit (24.1%), cerebellar (18.5%) and brainstem lesions (16.7%), pain (9.3%), acute disseminated encephalomyelitis like symptoms (1.9%), and hearing loss (3.7%). Visual evoked potentials were pathological in 75.9% of patients. Oligoclonal bands were positive in 68.5% of patients. Magnetic resonance imaging showed periventricular (94.4%), infratentorial (77.8%), juxtacortical and cortical changes (55.6%) and changes in the cervical spinal cord (33.3%). The median EDSS score was 2.0. Conclusion Our cohort significantly differs from the literature data regarding more frequent occurrence of optic neuritis, hearing loss as a first symptom, the relapsing-remitting course of the disease, higher proportion of early onset of disease, presence of co-occurring migraine and the frequent occurrence of epilepsy and other autoimmune diseases in the family.
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Yan K, Balijepalli C, Desai K, Gullapalli L, Druyts E. Epidemiology of pediatric multiple sclerosis: A systematic literature review and meta-analysis. Mult Scler Relat Disord 2020; 44:102260. [DOI: 10.1016/j.msard.2020.102260] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/08/2020] [Accepted: 06/01/2020] [Indexed: 10/24/2022]
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Barraza G, Deiva K, Husson B, Adamsbaum C. Imaging in Pediatric Multiple Sclerosis : An Iconographic Review. Clin Neuroradiol 2020; 31:61-71. [PMID: 32676699 DOI: 10.1007/s00062-020-00929-8] [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: 04/10/2020] [Accepted: 06/20/2020] [Indexed: 11/29/2022]
Abstract
Pediatric-onset multiple sclerosis (POMS) is defined by a first multiple sclerosis (MS) attack occurring before 18 years old and is diagnosed by demonstration of dissemination in time (DIT) and space (DIS). Although guidelines evolved over the years, they always recognized the importance of magnetic resonance imaging (MRI) for diagnosis. The 2017 McDonald criteria are increasingly used and have been validated in several cohorts. The use of MRI is the most important tool for the early diagnosis, monitoring, and assessment of treatment response of MS and standard protocols include precontrast and postcontrast T1, T2, fluid attenuation inversion recovery (FLAIR) and diffusion sequences. A distinctive MS lesion compromises white matter and it is well-demarcated and confluent, showing demyelination, inflammation, gliosis, and relative axonal preservation. Considering the growing recognition of pediatric MS as a differential diagnosis for children presenting with a clinical central nervous system event, we present a POMS lesions guide (periventricular, juxtacortical, infratentorial, spinal cord, cortical, tumefactive, black hole, contrast-enhanced). Owing to its rareness, POMS is a diagnosis by exclusion and MRI plays a fundamental role in distinguishing POMS from other demyelinating and non-demyelinating conditions. Three main groups of disorders can mimic POMS: inflammatory, metabolic and tumoral; however, imaging patterns earlier described lower the possibilities of alternative diagnoses and strongly suggest POMS when likely.
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Affiliation(s)
- Gonzalo Barraza
- Pediatric Radiology Department, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270, Le Kremlin-Bicêtre, France.
| | - Kumaran Deiva
- Pediatric Neurology Department, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270, Le Kremlin-Bicêtre, France.,Inserm UMR1184 "Immunology of viral infections and autoimmune diseases", CEA, IDMIT, Faculty of Medicine, Paris-Sud University, 94270, Le Kremlin-Bicêtre, France
| | - Béatrice Husson
- Pediatric Radiology Department, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270, Le Kremlin-Bicêtre, France.,Pediatric stroke National Reference Center, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270, Le Kremlin-Bicêtre, France
| | - Catherine Adamsbaum
- Pediatric Radiology Department, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270, Le Kremlin-Bicêtre, France.,Faculty of Medicine, Paris-Sud University, 94270, Le Kremlin-Bicêtre, France
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