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Ghezzi A. Old and New Strategies in the Treatment of Pediatric Multiple Sclerosis: A Personal View for a New Treatment Approach. Neurol Ther 2024; 13:949-963. [PMID: 38822947 PMCID: PMC11263277 DOI: 10.1007/s40120-024-00633-6] [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: 04/18/2024] [Accepted: 05/14/2024] [Indexed: 06/03/2024] Open
Abstract
Up to 10 years ago the most common approach to the treatment of pediatric MS (ped-MS) was to start with IFNB or GA (so-called first-line therapies or moderate-efficacy disease-modifying therapies [ME-DMTs]) and to switch to more aggressive treatments (or high-efficacy disease-modifying therapies [HE-DMTs]) in non-responder patients. The use of HE-DMTs as first choice was recommended in selected cases with an active, aggressive form of MS. Indications for the treatment of ped-MS were essentially derived from data of observational studies. Recently, results of three randomized clinical trials have been published as well as data from many observational studies evaluating the effect of new and more active DMTs, with clear evidence that HE-DMTs are more effective than ME-DMTs. Therefore, the paradigm of treatment for patients with MS onset before 18 years of age should be changed, offering treatment with HE-DMTs as first option, because of their superior effectiveness to prevent relapses and disease progression. HE-DMTs present an overall reassuring safety profile and obtain better adherence to treatment.
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Affiliation(s)
- Angelo Ghezzi
- Dipartimento di Scienze della Salute, Università Piemonte Orientale A. Avogadro, Via Solaroli 17, 28100, Novara, Italy.
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2
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Ghezzi A, Neuteboom RF. Neurofilament Light Chain in Adult and Pediatric Multiple Sclerosis: A Promising Biomarker to Better Characterize Disease Activity and Personalize MS Treatment. Neurol Ther 2023; 12:1867-1881. [PMID: 37682513 PMCID: PMC10630260 DOI: 10.1007/s40120-023-00535-z] [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: 07/05/2023] [Accepted: 08/15/2023] [Indexed: 09/09/2023] Open
Abstract
Many biological markers have been explored in multiple sclerosis (MS) to better quantify disease burden and better evaluate response to treatments, beyond clinical and MRI data. Among these, neurofilament light chain (Nf-L), although non-specific for this disease and found to be increased in other neurological conditions, has been shown to be the most promising biomarker for assessing axonal damage in MS, with a definite role in predicting the development of MS in patients at the first neurological episode suggestive of MS, and also in a preclinical phase. There is strong evidence that Nf-L levels are increased more in relapsing versus stable MS patients, and that they predict future disease evolution (relapses, progression, MRI measures of activity/progression) in MS patients, providing information on response to therapy, helping to anticipate clinical decisions in patients with an apparently stable evolution, and identifying patient non-responders to disease-modifying treatments. Moreover, Nf-L can contribute to the better understanding of the mechanisms of demyelination and axonal damage in adult and pediatric MS. A fundamental requirement for its clinical use is the accurate standardization of normal values, corrected for confounding factors, in particular age, sex, body mass index, and presence of comorbidities. In this review, a guide is provided to update clinicians on the use of Nf-L in clinical activity.
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Affiliation(s)
- Angelo Ghezzi
- Dipartimento di Scienze della Salute, Università Piemonte Orientale A. Avogadro, Via Solaroli 17, 28100, Novara, Italy.
| | - R F Neuteboom
- Department of Neurology, ErasMS Center, Erasmus MC, PO Box 2040, 3000, Rotterdam, The Netherlands
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3
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Ghezzi A, Neuteboom RF. The contribution of neurofilament light chain to better characterize pediatric multiple sclerosis (editorial on: Plasma neurofilament light chain in children with relapsing MS receiving teriflunomide or placebo: A post hoc analysis of the randomized TERIKIDS trial). Mult Scler 2023; 29:668-670. [PMID: 36960483 DOI: 10.1177/13524585231161148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Affiliation(s)
- Angelo Ghezzi
- Dipartimento di Scienze della Salute, Università degli Studi del Piemonte Orientale "Amedeo Avogadro," Novara, Italy
| | - Rinze F Neuteboom
- Department of Neurology, Eras MS Center, Erasmus University Medical Center, Rotterdam, The Netherlands
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Bunyan RF, AlAbdulSalam AM, Albarakati RG, Al Harbi AA, Alissa DA, Al-Jedai AH, AlKhawajah NM, Al Malik YM, Almejally MA, Al-Mudaiheem HY, AlNajashi HA, AlShehri AA, Althubaiti IA, AlYafeai RH, Babakkor MA, Cupler EJ, Ka MH, Saeedi JA, Shosha E, Al Jumah MA. Saudi consensus recommendations on the management of multiple sclerosis: MS management in children and adolescents. Mult Scler Relat Disord 2022; 66:104061. [PMID: 35908447 DOI: 10.1016/j.msard.2022.104061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/26/2022] [Accepted: 07/15/2022] [Indexed: 12/01/2022]
Abstract
Multiple sclerosis (MS) most commonly presents in young adults, although 3-5% of patients develop MS prior to the age of 18 years. The new and comprehensive consensus for the management of MS in Saudi Arabia includes recommendations for the management of MS and other CNS inflammatory demyelinating disorders in pediatric and adolescent patients. This article summarizes the key recommendations for the diagnosis and management of these disorders in young patients. Pediatric and adult populations with MS differ in their presentation and clinical course. Careful differential diagnosis is important to exclude alternative diagnoses such as acute disseminated encephalomyelitis (ADEM) or neuromyelitis optica spectrum disorders (NMOSD). The diagnosis of MS in a pediatric/adolescent patient is based on the 2017 McDonald diagnostic criteria, as in adults, once the possibility of ADEM or NMOSD has been ruled out. Few data are available from randomized trials to support the use of a specific disease-modifying therapy (DMT) in this population. Interferons and glatiramer acetate are preferred initial choices for DMTs based on observational evidence, with the requirement of a switch to a more effective DMT if breakthrough MS activity occurs.
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Affiliation(s)
- Reem F Bunyan
- Department of Neurology, King Fahad Specialist Hospital Dammam, Eastern Region, Saudi Arabia
| | | | - Rayan G Albarakati
- Department of Obstetrics and Gynecology, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Awad A Al Harbi
- Department of Neuroscience, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Dema A Alissa
- Deputyship of Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia
| | - Ahmed H Al-Jedai
- Deputyship of Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia
| | - Nuha M AlKhawajah
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Division of Neurology, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Yaser M Al Malik
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Division of Neurology, King Abdulaziz Medical City (National Guard Health Affairs), Riyadh, Saudi Arabia
| | | | | | - Hind A AlNajashi
- Department of Medicine, Division of Neurology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amani A AlShehri
- Pharmaceutical Care Services, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ibtisam A Althubaiti
- Department of Neurology, King Fahad Military Medical Complex Dhahran, Eastern Region, Saudi Arabia
| | - Rumaiza H AlYafeai
- Department of Psychiatry and Psychology, My Clinic International Medical Co., Jeddah, Saudi Arabia
| | - Mohammed A Babakkor
- Neurology Department, Neuroscience Center, King Abdullah Medical City, Ministry of Health, Makkah Al-Mukarramah, Saudi Arabia
| | - Edward J Cupler
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mamdouh H Ka
- Department of Neurology, Al Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Jameelah A Saeedi
- Department of Neuroscience, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Eslam Shosha
- Department of Medicine, Division of Neurology, McMaster University, Hamilton, Ontario, Canada
| | - Mohammed A Al Jumah
- Department of Neurology, King Fahad Medical City, Ministry of Health, Riyadh, Saudi Arabia.
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Solmaz I, Acar Ozen P, Parlak S, Tuncer A, Anlar B. Newer disease modifying treatments in pediatric onset multiple sclerosis: Experience from a single center. Eur J Paediatr Neurol 2022; 39:110-115. [PMID: 35777190 DOI: 10.1016/j.ejpn.2022.06.013] [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: 12/14/2021] [Revised: 04/18/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Disease modifying treatments (DMTs) for multiple sclerosis include injectable drugs (iDMTs) like interferons (IFNs) or glatiramer acetate (GA), and newer agents (nDMTs) in oral and intravenous forms. nDMTs are usually applied in escalation and less frequently as initial treatment in pediatric-onset (POMS). OBJECTIVE We intended to evaluate the effect of nDMTs in comparison with iDMTs by retrospective examination of our patients with POMS. METHOD Clinical records of POMS cases who received nDMTs either as escalation or initial treatment and who had at least 12 months' follow-up in our clinic were examined in two groups: patients who were started on iDMTs and later switched to nDMTs (Group A), and those who received nDMTs from the beginning (Group B). Presenting symptoms, annualized relapsing rate (ARR), recent Expanded Disability Status Scale (EDSS), lesion load and presence of contrast enhancing (CE) lesions on magnetic resonance imaging (MRI) were compared. RESULTS Total 43 patients were included: 33 in Group A and 10 in Group B. Age at onset, female/male ratio, duration since disease onset and duration under nDMT were similar in both groups. Initial involvement was predominantly brainstem and cerebellar in Group A and sensorial, brainstem/cerebellar, and optic nerve in Group B. The most frequently used nDMT was fingolimod in Group A (n = 17, 51.5%) and teriflunomide (n = 6, 60%) in Group B. Median ARR before any treatment was 2 in Group A and 1.5 in Group B (p > 0.05); it decreased to median 1 under iDMTs in Group A and to 0 under nDMTs. Mean follow-up was 6.7 ± 5 years (1-19, median 6 years) in Group A and 3.9 ± 3.7 years (range 1-12, median 2 years) in Group B. At the latest follow-up median EDSS scores were 1 in Group A and 0 in Group B. ARR had increased and lesion load on MRI went up progressively in both groups during follow-up. However, the rate of patients with CE lesions diminished in Group B. CONCLUSION This single-center study of POMS shows the ARR decreases under any treatment, more markedly under nDMTs, and nDMTs reduce the rate of patients with CE lesions on MRI without a clear effect on lesion load. The ARR tends to increase after the first 2 years of both iDMT and nDMT, suggesting a re-evaluation at that time. The ARR decreases shorty after treatment is changed from an iDMT to a nDMT.
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Affiliation(s)
- Ismail Solmaz
- Hacettepe University, Faculty of Medicine, Department of Pediatric Neurology, Ankara, Turkey.
| | - Pınar Acar Ozen
- Hacettepe University, Faculty of Medicine, Department of Neurology, Ankara, Turkey
| | - Safak Parlak
- Hacettepe University, Faculty of Medicine, Department of Radiology, Ankara, Turkey
| | - Aslı Tuncer
- Hacettepe University, Faculty of Medicine, Department of Neurology, Ankara, Turkey
| | - Banu Anlar
- Hacettepe University, Faculty of Medicine, Department of Pediatric Neurology, Ankara, Turkey
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Ganelin-Cohen E, Tartakovsky E, Klepfish E, Golderman S, Rozenberg A, Kaplan B. Personalized Disease Monitoring in Pediatric Onset Multiple Sclerosis Using the Saliva Free Light Chain Test. Front Immunol 2022; 13:821499. [PMID: 35450065 PMCID: PMC9016751 DOI: 10.3389/fimmu.2022.821499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/11/2022] [Indexed: 12/15/2022] Open
Abstract
Background Development of new safe methods of monitoring disease activity in the pediatric onset multiple sclerosis (POMS) is a challenging task, especially when trying to refrain from frequent MRI usage. In our recent study, the saliva immunoglobulin free light chains (FLC) were suggested as biomarkers to discriminate between remission and active MS in adults. Objectives To assess utility of saliva FLC measurements for monitoring disease activity in POMS. Methods We used semiquantitative Western blot analysis to detect immunoreactive FLC monomers and dimers and to calculate the intensity of their bands. Statistical tests included Firth logistic regression analysis suitable for small sample sizes, and Spearman's non-parametric correlation. Results In naive POMS patients, the saliva levels of FLC in relapse were significantly higher than those in remission. Significant correlation was found between FLC levels (monomers, dimers or both) and the load of enhanced lesions in MRI scans. FLC levels may be reduced under treatment, especially as result of corticosteroids therapy. Follow-up of individual patients showed the correspondence of changes in the FLC levels to MRI findings. Conclusions Our results show the potential of the non-invasive saliva FLC test, as a new tool for monitoring the disease activity in POMS.
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Affiliation(s)
- Esther Ganelin-Cohen
- Institute of Pediatric Neurology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - Sizilia Golderman
- Heller Institute of Medical Research, Sheba Medical Center, Ramat Gan, Israel
| | - Ayal Rozenberg
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Batia Kaplan
- Heller Institute of Medical Research, Sheba Medical Center, Ramat Gan, Israel
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Gärtner J, Hauser SL, Bar-Or A, Montalban X, Cohen JA, Cross AH, Deiva K, Ganjgahi H, Häring DA, Li B, Pingili R, Ramanathan K, Su W, Willi R, Kieseier B, Kappos L. Efficacy and safety of ofatumumab in recently diagnosed, treatment-naive patients with multiple sclerosis: Results from ASCLEPIOS I and II. Mult Scler 2022; 28:1562-1575. [PMID: 35266417 PMCID: PMC9315184 DOI: 10.1177/13524585221078825] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: In the phase III ASCLEPIOS I and II trials, participants with relapsing
multiple sclerosis receiving ofatumumab had significantly better clinical
and magnetic resonance imaging (MRI) outcomes than those receiving
teriflunomide. Objectives: To assess the efficacy and safety of ofatumumab versus teriflunomide in
recently diagnosed, treatment-naive (RDTN) participants from ASCLEPIOS. Methods: Participants were randomized to receive ofatumumab (20 mg subcutaneously
every 4 weeks) or teriflunomide (14 mg orally once daily) for up to
30 months. Endpoints analysed post hoc in the protocol-defined RDTN
population included annualized relapse rate (ARR), confirmed disability
worsening (CDW), progression independent of relapse activity (PIRA) and
adverse events. Results: Data were analysed from 615 RDTN participants (ofatumumab:
n = 314; teriflunomide: n = 301). Compared
with teriflunomide, ofatumumab reduced ARR by 50% (rate ratio (95%
confidence interval (CI)): 0.50 (0.33, 0.74);
p < 0.001), and delayed 6-month CDW by 46% (hazard ratio
(HR; 95% CI): 0.54 (0.30, 0.98); p = 0.044) and 6-month
PIRA by 56% (HR: 0.44 (0.20, 1.00); p = 0.049). Safety
findings were manageable and consistent with those of the overall ASCLEPIOS
population. Conclusion: The favourable benefit–risk profile of ofatumumab versus teriflunomide
supports its consideration as a first-line therapy in RDTN patients. ASCLEPIOS I and II are registered at ClinicalTrials.gov (NCT02792218 and
NCT02792231).
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Affiliation(s)
- Jutta Gärtner
- Department of Paediatrics and Adolescent Medicine, Division of Paediatric Neurology, University Medical Centre Göttingen, Georg August University Göttingen, Göttingen, Germany
| | - Stephen L Hauser
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California - San Francisco, San Francisco, CA, USA
| | - Amit Bar-Or
- Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Xavier Montalban
- Department of Neurology-Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jeffrey A Cohen
- Department of Neurology, Mellen MS Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anne H Cross
- Department of Neurology, Section of Neuroimmunology, Washington University School of Medicine, St Louis, MO, USA
| | - Kumaran Deiva
- Department of Pediatric Neurology, University Hospitals Paris Saclay, Hôpital Bicêtre, National Reference Center for Rare Inflammatory Brain and Spinal Diseases, Le Kremlin-Bicêtre, France
| | - Habib Ganjgahi
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Population Health, University of Oxford, Oxford, UK/Statistics Department, University of Oxford, Oxford, UK
| | | | - Bingbing Li
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | - Wendy Su
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) and MS Center, and Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital of Basel, University of Basel, Basel, Switzerland
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Kesselring J, Boyko A, Laroni A, Bharadia T, van Galen P, Alexandri N. Caregiver Involvement in MS: Duty or Disruption? Neurol Ther 2022; 11:9-20. [PMID: 34792783 PMCID: PMC8857341 DOI: 10.1007/s40120-021-00299-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 11/01/2021] [Indexed: 11/06/2022] Open
Abstract
Multiple sclerosis (MS) is a complex condition with numerous physical, cognitive and emotional symptoms. These may necessitate significant, permanent lifestyle changes for people with multiple sclerosis (PwMS) and their caregivers and families, meaning it is important in contemporary neurological practice to consider including families and/or caregivers in the management of MS. However, existing evidence suggests that family involvement is not always beneficial; for example, it can exert either a strong positive or negative influence on the ability of PwMS to achieve optimal outcomes from their treatment and disease management. This paper, based on a live debate between neurologists and PwMS, examines the current perceptions on constructive involvement of families and caregivers in consultations for and management of MS, and reveals several areas where additional studies are warranted. Shared decision-making in MS has historically been a collaboration solely between healthcare professionals (HCPs) and PwMS, but PwMS are now more frequently being accompanied to appointments by a support person. This paper encourages HCPs to understand the dynamics between PwMS and their support person, and to individualize consultations and information accordingly. Family and caregiver involvement in the provision of care for PwMS needs to be for the benefit of, and at the discretion of, the PwMS. Support for families of PwMS, although important, may be more effectively and appropriately delivered through other channels outside of the clinical setting. Educating HCPs on the current patient experience to enable them to provide improved personalized care will ensure a mutualistic, patient-centred relationship with PwMS, which will help to optimize outcomes. Communication tools may also facilitate these interactions.
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Affiliation(s)
- Jürg Kesselring
- Department of Neurology and Neurorehabilitation, Kliniken Valens, Valens, Switzerland.
| | - Alexey Boyko
- Institute of Clinical Neurology and Department of Neuroimmunology of the Federal Centre of Brain Research and Neurotechnologies, Pirogov's Russian National Research Scientific Medical University, Moscow, Russia
| | - Alice Laroni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Trishna Bharadia
- Patient Author, Member of the MS in the 21st Century Steering Group, Buckinghamshire, UK
| | - Pieter van Galen
- Patient Author, Member of the MS in the 21st Century Steering Group, Overijse, Belgium
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Nikolic B, Zaletel I, Ivancevic N, Rovcanin B, Pepic A, Samardzic J, Jancic J. The usefulness of visual evoked potentials in the assessment of the pediatric multiple sclerosis. Eur J Paediatr Neurol 2022; 36:130-136. [PMID: 34959110 DOI: 10.1016/j.ejpn.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 10/26/2021] [Accepted: 12/07/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND To evaluate the significance of visual evoked potentials (VEP) in the early diagnosis of optic neuritis (ON) and detecting clinically silent lesions in pediatric multiple sclerosis (PedMS). This study represents one of the largest series of PedMS which evaluated characteristics of VEP in PedMS patients. METHODS This was a retrospective study on 52 PedMS patients, aged 7-17 years. VEP analysis were done for all patients, after the first attack of disease and were compared to control subjects according to the pattern-reversal VEP findings. RESULTS The mean age of patients was 15.65 ± 1.89 years with male to female ratio of 16 (30.8%): 36 (69.2%). All of the patients had a relapsing-remitting course of the disease. ON was discovered on the initial attack in 18 (34.6%) patients, while 30 (57.7%) patients had ON in the second attack. Pathological VEP findings were present in 40 (76.9%) patients, of which 22 (42.3%) PedMS patients had clinically silent lesions. Prolonged latency of P100 waves in the PedMS group was statistically significant when compared to control subjects. The amplitude N1P1 showed a correlation with residual visual deficit. CONCLUSION Our results show that ON is a common initial manifestation of PedMS in the Serbian PedMS population. The prolonged P100 latency is the main indicator of ON. VEP is an objective, fast and accessible diagnostic method for detecting clinical and subclinical lesions. Thus, VEP deserves evaluation to be considered as an additional criterion for PedMS diagnosis.
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Affiliation(s)
- Blazo Nikolic
- Clinic of Neurology and Psychiatry for Children and Youth, Dr. Subotica 6a, 11000, Belgrade, Serbia
| | - Ivan Zaletel
- Institute of Histology and Embryology "Aleksandar D. Kostic", Deligradska 35, 11000, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia
| | - Nikola Ivancevic
- Clinic of Neurology and Psychiatry for Children and Youth, Dr. Subotica 6a, 11000, Belgrade, Serbia
| | - Branislav Rovcanin
- Center for Endocrine Surgery, Clinical Center of Serbia, KosteTodorovica 8, 11000, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia
| | - Ana Pepic
- Clinic of Neurology and Psychiatry for Children and Youth, Dr. Subotica 6a, 11000, Belgrade, Serbia
| | - Janko Samardzic
- Institute of Pharmacology, Clinical Pharmacology and Toxicology, Dr. Subotica 1/ III, 11000, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia
| | - Jasna Jancic
- Clinic of Neurology and Psychiatry for Children and Youth, Dr. Subotica 6a, 11000, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia.
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10
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Luca M, Ortega-Castro N, Patti F. Paediatric Multiple Sclerosis: A Scoping Review of Patients' and Parents' Perspectives. CHILDREN (BASEL, SWITZERLAND) 2021; 9:11. [PMID: 35053636 PMCID: PMC8773986 DOI: 10.3390/children9010011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/13/2021] [Accepted: 12/20/2021] [Indexed: 11/17/2022]
Abstract
Dealing with paediatric-onset multiple sclerosis is particularly challenging for the young patients and their families, due to its unpredictable symptoms and uncertain outcome. This review aimed at synthesising the qualitative evidence regarding the perspectives about paediatric-onset multiple sclerosis, as expressed by the patients and/or their parents. A literature search was conducted on PubMed and CINAHL. The advanced multi-field search allowed to perform an abstract/title search in both databases, using keywords, combined through Boolean operators. Additional search strategies were adopted: searching the reference list of the selected papers; searching for key authors in the field. All the relevant papers were thoroughly revised using The Joanna Briggs Institute's data extraction form for qualitative evidence as a guidance. Eight papers were selected. The analysis of these papers allowed to identify some common issues pertaining paediatric-onset multiple sclerosis: (1) onset of symptoms, (2) diagnostic process, (3) reaction to the diagnosis, (4) management and acceptance of multiple sclerosis. The burden of multiple sclerosis was confirmed. However, the young patients and their parents can adjust to the disease. Both the community and the health care professionals must strive to prevent the families dealing with multiple sclerosis from experiencing solitude and rejection.
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Affiliation(s)
- Maria Luca
- Centre for Addiction, Via Pò 2, 95031 Adrano, Italy
| | | | - Francesco Patti
- Department “GF Ingrassia”, Section of Neurosciences, University of Catania, 95125 Catania, Italy;
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11
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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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12
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McKay KA, Wickström R, Hillert J, Karrenbauer VD. Cerebrospinal fluid markers in incident pediatric-onset multiple sclerosis: a nationwide study. Sci Rep 2021; 11:18528. [PMID: 34535701 PMCID: PMC8448868 DOI: 10.1038/s41598-021-97543-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/26/2021] [Indexed: 01/12/2023] Open
Abstract
To investigate whether cerebrospinal fluid (CSF) markers differ between pediatric-onset multiple sclerosis (PoMS, onset < 18 years) and adult-onset (AoMS), and whether these markers are associated with clinical outcomes among PoMS. Prospective nationwide registry study of incident MS, including persons with a CSF sample < 3 years post-MS onset. We compared CSF oligoclonal band (OCB) status, immunoglobulin G (IgG) index levels, and mononuclear cell count between PoMS and AoMS. Within the PoMS cohort we analyzed the association between CSF markers, relapse rate and Expanded Disability Status Scale (EDSS) score, using negative binomial regression and generalized estimating equations, respectively. The cohort consisted of 130 PoMS and 3228 AoMS cases. The PoMS group had higher odds of OCB-positivity (odds ratio: 2.70; 95% CI 1.21–7.67). None of the CSF markers were associated with relapse rate in the PoMS cohort; however, OCB-positivity was associated with higher EDSS scores. This study suggested that PoMS more commonly display CSF evidence for intrathecal IgG production than AoMS. Further, we found evidence of a relationship between OCB-positivity and subsequent disability, suggesting that they could play a role in the prognostication of MS in children.
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Affiliation(s)
- Kyla A McKay
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. .,Center for Molecular Medicine (CMM) L8:05, Karolinska University Hospital, 171 76, Stockholm, Sweden.
| | - Ronny Wickström
- Neuropediatric Unit, Astrid Lindgren's Childrens's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Virginija Danylaite Karrenbauer
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Theme Neuro, Karolinska University Hospital, Stockholm, Sweden
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13
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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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14
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Comi G, Bar-Or A, Lassmann H, Uccelli A, Hartung HP, Montalban X, Sørensen PS, Hohlfeld R, Hauser SL. Role of B Cells in Multiple Sclerosis and Related Disorders. Ann Neurol 2020; 89:13-23. [PMID: 33091175 DOI: 10.1002/ana.25927] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/05/2020] [Accepted: 10/05/2020] [Indexed: 12/22/2022]
Abstract
The success of clinical trials of selective B-cell depletion in patients with relapsing multiple sclerosis (MS) and primary progressive MS has led to a conceptual shift in the understanding of MS pathogenesis, away from the classical model in which T cells were the sole central actors and toward a more complex paradigm with B cells having an essential role in both the inflammatory and neurodegenerative components of the disease process. The role of B cells in MS was selected as the topic of the 27th Annual Meeting of the European Charcot Foundation. Results of the meeting are presented in this concise review, which recaps current concepts underlying the biology and therapeutic rationale behind B-cell-directed therapeutics in MS, and proposes strategies to optimize the use of existing anti-B-cell treatments and provide future directions for research in this area. ANN NEUROL 2021;89:13-23.
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Affiliation(s)
- Giancarlo Comi
- Institute of Experimental Neurology, San Raffaele Hospital, Milan, Italy
| | - Amit Bar-Or
- Department of Neurology, Center for Neuroinflammation and Neurotherapeutics, University of Pennsylvania, Philadelphia, PA
| | - Hans Lassmann
- Department of Neuroimmunology (Center for Brain Research), University Hospital Vienna, Vienna, Austria
| | - Antonio Uccelli
- Department of Neuroscience, Genetic Ophthalmology, and Infant Maternity Science, San Martino Polyclinic Hospital, Genoa, Italy
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Xavier Montalban
- Neurology-Neuroimmunology Department and Neurorehabilitation Unit, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Per Solberg Sørensen
- Department of Neurology, Danish Multiple Sclerosis Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Reinhard Hohlfeld
- Institute of Clinical Neuroimmunology, Ludwig Maximilians University of Munich and Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Stephen L Hauser
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA
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15
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Duncan M, Carroll S, Cockburn R, Johnston C, Bullock H, Mitchell S, Hemingway C. Psychosocial impact of paediatric demyelinating disorders: a scoping review. Dev Med Child Neurol 2020; 62:1250-1258. [PMID: 32749683 DOI: 10.1111/dmcn.14629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2020] [Indexed: 12/31/2022]
Abstract
AIM To: (1) provide greater insight into the psychological and social impact of a range of demyelinating disorders, (2) explore differences between disorders, and (3) provide direction for future research. METHOD Studies were identified by searching online databases. Studies that explored the psychological, emotional, or social impact of a range of demyelinating disorders in childhood, including acute disseminated encephalomyelitis (ADEM), optic neuritis, transverse myelitis, and multiple sclerosis, were included and screened independently by three authors. Data on the design, sample characteristics, psychosocial measures, key findings, and methodological strengths and limitations were extracted. Twenty-five studies were included in the narrative synthesis. RESULTS Demyelinating disorders are associated with lower quality of life, affecting young people's emotional, social, school, and behavioural functioning. There is a high prevalence of psychiatric disorders and fatigue, particularly in multiple sclerosis. Subtle differences exist in the psychological presentation between different demyelinating disorders, with clear gaps in the research for the long-term psychosocial impact of monophasic conditions. INTERPRETATION The difference between the impact of monophasic and relapsing demyelinating disorders on psychosocial functioning is unclear. Future research should aim to identify the psychosocial impact across disorders and over time, ensure that services are capturing those patients who may benefit from tailored interventions. WHAT THIS PAPER ADDS Prevalence of psychiatric diagnoses in paediatric demyelinating disorders is higher than controls. Depression and emotional concerns are elevated in paediatric demyelinating disorders. Demyelinating disorders impact children's quality of life across school, social, and physical functioning.
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Affiliation(s)
- Morvwen Duncan
- Psychological Services, Great Ormond Street Hospital for Children, London, UK
| | - Susan Carroll
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Rebecca Cockburn
- Psychological Services, Great Ormond Street Hospital for Children, London, UK
| | - Claudia Johnston
- Psychological Services, Great Ormond Street Hospital for Children, London, UK
| | - Hayley Bullock
- Psychological Services, Great Ormond Street Hospital for Children, London, UK
| | - Sophie Mitchell
- Psychological Services, Great Ormond Street Hospital for Children, London, UK
| | - Cheryl Hemingway
- Department of Neurology, Great Ormond Street Hospital for Children, London, UK
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16
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Cobo-Calvo A, Ruiz A, Rollot F, Arrambide G, Deschamps R, Maillart E, Papeix C, Audoin B, Lépine AF, Maurey H, Zephir H, Biotti D, Ciron J, Durand-Dubief F, Collongues N, Ayrignac X, Labauge P, Meyer P, Thouvenot E, Bourre B, Montcuquet A, Cohen M, Horello P, Tintoré M, De Seze J, Vukusic S, Deiva K, Marignier R. Clinical Features and Risk of Relapse in Children and Adults with Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease. Ann Neurol 2020; 89:30-41. [PMID: 32959427 DOI: 10.1002/ana.25909] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The main objective was to compare clinical features, disease course, and myelin oligodendrocyte glycoprotein (MOG) antibody (Ab) dynamics between children and adults with MOG-Ab-associated disease (MOGAD). METHODS This retrospective multicentric, national study included 98 children and 268 adults with MOGAD between January 2014 and September 2019. Cox regression model for recurrent time-to-event data and Kaplan-Meier curves for time to antibody negativity were performed for the objectives. RESULTS Isolated optic neuritis was the most frequent clinical presentation in both children (40.8%) and adults (55.9%, p = 0.013), and acute disseminated encephalomyelitis syndrome was more frequent in children (36.7% vs 5.6%, p < 0.001). Compared to adults, children displayed better recovery (Expanded Disability Status Scale ≥ 3.0 at last follow-up reached only by 10 of 97 [10.3%] vs 66/247 [26.7%], p < 0.001). In the multivariate analysis, adults were at higher risk of relapse than children (hazard ratio = 1.41, 95% confidence interval [CI] = 1.12-1.78, p = 0.003). At 2 years, 64.2% (95% CI = 40.9-86.5) of nonrelapsing children became MOG-Ab negative compared to 14.1% (95% CI = 4.7-38.3) of relapsing children (log-rank p < 0.001), with no differences observed in adults (log-rank p = 0.280). INTERPRETATION MOGAD patients differ in the clinical presentation at onset, showing an age-related shift in the clinical features across age groups. Compared to children, adults have a higher risk of relapse and worse functional recovery. Finally, children with monophasic disease become MOG-Ab negative earlier than relapsing children, but this is not true in adults. Considering these differences, management and treatment guidelines should be considered independently in children and adults. ANN NEUROL 2021;89:30-41.
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Affiliation(s)
- Alvaro Cobo-Calvo
- Department of Neurology, Multiple Sclerosis and Neuroinflammation, Pierre Wertheimer Neurological Hospital, Lyon Civil Hospices, Lyon, France.,Department of Neurology-Neuroimmunology, Multiple Sclerosis Center Catalonia, Vall d'Hebron Institute of Research, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain.,Lyon Neuroscience Research Center, U1028 INSERM, UMR5292 CNRS, FLUID Team, Lyon, France
| | - Anne Ruiz
- Lyon Neuroscience Research Center, U1028 INSERM, UMR5292 CNRS, FLUID Team, Lyon, France
| | - Fabien Rollot
- University of Lyon, Claude Bernard University Lyon 1, Lyon Civil Hospices, EDMUS Foundation, OFSEP, Lyon Neuroscience Research Center, Lyon, France
| | - Georgina Arrambide
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Center Catalonia, Vall d'Hebron Institute of Research, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Romain Deschamps
- Department of Neurology, Adolphe de Rothschild Hospital Foundation, Paris, France
| | - Elisabeth Maillart
- Department of Neurology and Reference Center for Rare Inflammatory Diseases of the Brain and Bone, Pitié-Salpêtrière Hospital, Public Hospital Network of Paris, Paris, France
| | - Caroline Papeix
- Department of Neurology and Reference Center for Rare Inflammatory Diseases of the Brain and Bone, Pitié-Salpêtrière Hospital, Public Hospital Network of Paris, Paris, France
| | - Bertrand Audoin
- Aix-Marseille University, Public Assistance Hospitals of Marseille, Timone Hospital, Clinical Neuroscience Center, Neurology Department, Marseille, France
| | - Anne Fabienne Lépine
- Pediatric Neurology Department, Timone Hospital, Public Assistance Hospitals of Marseille, Marseille, France
| | - Hélène Maurey
- National Referral Center for Neuroinflammatory Diseases and Pediatric Neurology Department, Public Hospital Network of Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France.,Department of Neuropediatrics, University of Paris-Sud, Le Kremlin-Bicêtre, France
| | - Helene Zephir
- University Lille, INSERM, CHU Lille, U1172-Laboratory of Neuroinflammation and Multiple Sclerosis, Lille Neuroscience & Cognition, Lille, France.,Department of Neurology, SEP Resource and Competence Center, Lille, France
| | - Damien Biotti
- Department of Neurology, CRC-SEP, Toulouse University Hospital, Toulouse, France
| | - Jonathan Ciron
- Department of Neurology, CRC-SEP, Toulouse University Hospital, Toulouse, France
| | - Francoise Durand-Dubief
- Department of Neurology, Multiple Sclerosis and Neuroinflammation, Pierre Wertheimer Neurological Hospital, Lyon Civil Hospices, Lyon, France
| | - Nicolas Collongues
- Department of Neurology and Clinical Investigation Center, INSERM 1434, Strasbourg University Hospital, Strasbourg, France
| | - Xavier Ayrignac
- Department of Neurology, Montpellier University Hospital, Montpellier, France
| | - Pierre Labauge
- Department of Neurology, Montpellier University Hospital, Montpellier, France
| | - Pierre Meyer
- Department of Pediatric Neurology, CHU Montpellier, PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Eric Thouvenot
- Department of Neurology, Carémeau Hospital, Nimes University Hospital, Nimes, France
| | - Bertrand Bourre
- Department of Neurology, Rouen University Hospital, Rouen, France
| | | | - Mikael Cohen
- Department of Neurology, CRCSEP, Cote d'Azur Clinical Research Unit, Pasteur University Hospital Center 2, Nice, France
| | - Philippe Horello
- Division of Immunovirology, INSERM, U1184, Center for Immunology of Viral Infections and Autoimmune Diseases, University of Paris-Sud 11, CEA, DSV/iMETI, IDMIT, Faculty of Medicine, Le Kremlin-Bicêtre, France
| | - Mar Tintoré
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Center Catalonia, Vall d'Hebron Institute of Research, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Jerome De Seze
- Department of Neurology and Clinical Investigation Center, INSERM 1434, Strasbourg University Hospital, Strasbourg, France
| | - Sandra Vukusic
- Department of Neurology, Multiple Sclerosis and Neuroinflammation, Pierre Wertheimer Neurological Hospital, Lyon Civil Hospices, Lyon, France.,Lyon Neuroscience Research Center, U1028 INSERM, UMR5292 CNRS, FLUID Team, Lyon, France.,University of Lyon, Claude Bernard University Lyon 1, Lyon Civil Hospices, EDMUS Foundation, OFSEP, Lyon Neuroscience Research Center, Lyon, France
| | - Kumaran Deiva
- Pediatric Neurology Department, National Referral Center for Rare Inflammatory Brain and Spinal Diseases, Public Hospital Network of Paris, University of Paris-Sud Hospitals, Bicêtre Hospital, Le Kremlin-Bicêtre, France.,Center for Immunology of Viral Infections and Autoimmune Diseases, University of Paris-Sud, UMR 1184-CEA-IDMIT, Le Kremlin-Bicêtre, France
| | - Romain Marignier
- Department of Neurology, Multiple Sclerosis and Neuroinflammation, Pierre Wertheimer Neurological Hospital, Lyon Civil Hospices, Lyon, France.,Lyon Neuroscience Research Center, U1028 INSERM, UMR5292 CNRS, FLUID Team, Lyon, France
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17
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Ghezzi A, Amato MP, Edan G, Hartung HP, Havrdová EK, Kappos L, Montalban X, Pozzilli C, Sorensen PS, Trojano M, Vermersch P, Comi G. The introduction of new medications in pediatric multiple sclerosis: Open issues and challenges. Mult Scler 2020; 27:479-482. [PMID: 32539596 DOI: 10.1177/1352458520930620] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Disease-modifying drugs (DMDs) for multiple sclerosis (MS) have been evaluated in pediatric patients in observational studies demonstrating a similar, even better clinical effect compared to adults, with a similar safety. Only fingolimod has been tested in a randomized controlled trial (RCT) and is approved for pediatric multiple sclerosis (ped-MS). Numerous methodological, practical, and ethical issues underline that RCTs are difficult to conduct in ped-MS. This also creates a lack of safety information. To facilitate the availability of new agents in ped-MS, we encourage to develop a different approach based on pharmacokinetic/pharmacodynamic studies to yield information on optimal doses and implementation of obligatory registries to obtain information on safety as primary endpoint.
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Affiliation(s)
- Angelo Ghezzi
- Centro Studi Sclerosi Multipla, Ospedale di Gallarate, Gallarate, Italy
| | - Maria Pia Amato
- Department of NEUROFARBA, University of Florence, Florence, Italy; IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Gilles Edan
- CIC 1414 INSERM, Department of Neurology, CHU Rennes, Rennes, France
| | - Hans-Peter Hartung
- Department of Neurology, UKD and Center of Neurology and Neuropsychiatry, Heinrich-Heine-University, Düsseldorf, Germany
| | - Eva Kubala Havrdová
- Department of Neurology and Center for Clinical Neuroscience, First Medical Faculty, Charles University, Prague, Czech Republic
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital and University of Basel, Basel, Switzerland
| | - Xavier Montalban
- St Michael's Hospital, University of Toronto, Toronto, ON, Canada; Department of Neurology, Cemcat, Hospital Vall d'Hebron, Barcelona, Spain
| | - Carlo Pozzilli
- Multiple Sclerosis Center, Sant' Andrea Hospital, Rome, Italy
| | - Per Soelber Sorensen
- Department of Neurology, Danish Multiple Sclerosis Center, Copenhagen University and Rigshospitalet, Copenhagen, Denmark
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Patrich Vermersch
- University of Lille, INSERM UMR-S1172, CHU Lille, FHU Imminent, Lille, France
| | - Giancarlo Comi
- Istituto di Neurologia Sperimentale (INSPE), IRCCS Ospedale San Raffaele, Milan, Italy
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18
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Baroncini D, Annovazzi P, Guaschino C, Minonzio G, Hametner S, Stadelmann C, Comi G, Ghezzi A, Zaffaroni M. Long-term remission of tumefactive relapsing multiple sclerosis after alemtuzumab rescue treatment in an adolescent patient. Mult Scler Relat Disord 2020; 41:102061. [PMID: 32203930 DOI: 10.1016/j.msard.2020.102061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/22/2020] [Accepted: 03/15/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Damiano Baroncini
- Multiple Sclerosis Centre, ASST Valle Olona, Gallarate Hospital, Gallarate, VA, Italy.
| | - P Annovazzi
- Multiple Sclerosis Centre, ASST Valle Olona, Gallarate Hospital, Gallarate, VA, Italy
| | - C Guaschino
- Multiple Sclerosis Centre, ASST Valle Olona, Gallarate Hospital, Gallarate, VA, Italy
| | - G Minonzio
- Neuroradiology Unit, ASST Valle Olona, Gallarate Hospital, Gallarate, VA, Italy
| | - S Hametner
- Institute of Neurology, Medical University Vienna, Vienna, Austria; Institute of Neuropathology, University Medical Center, Göttingen, Germany
| | - C Stadelmann
- Institute of Neuropathology, University Medical Center, Göttingen, Germany
| | - G Comi
- Department of Neurology, Institute of Experimental Neurology, San Raffaele Hospital, Milan, Italy
| | - A Ghezzi
- Multiple Sclerosis Centre, ASST Valle Olona, Gallarate Hospital, Gallarate, VA, Italy
| | - M Zaffaroni
- Multiple Sclerosis Centre, ASST Valle Olona, Gallarate Hospital, Gallarate, VA, Italy
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19
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Pollini L, Tolve M, Nardecchia F, Galosi S, Carducci C, di Carlo E, Carducci C, Leuzzi V. Multiple sclerosis and intracellular cobalamin defect ( MMACHC/ PRDX1) comorbidity in a young male. Mol Genet Metab Rep 2020; 22:100560. [PMID: 32099815 PMCID: PMC7026611 DOI: 10.1016/j.ymgmr.2019.100560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/19/2019] [Accepted: 12/21/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Methylmalonic acidaemia with homocystinuria type C (cblC defect) is an inherited error of cobalamin metabolism. Cobalamin deficient processing results in high levels of methylmalonic acid and homocysteine. The latter is considered to be a risk factor for multiple sclerosis (MS). We report on the first case of a patient with comorbid cblC defect and MS. CASE REPORT This young male presented at the age of 14 with a relapsing-remitting neurological disorder associated with imaging alterations suggestive of MS. Treatment resulted in a partial clinical improvement with vanishing of white matter lesions. Later on, the emergence of unexpected clinical features led to a metabolic work-up, revealing a cobalamin intracellular defect. Genetic analysis disclosed a single variant in MMACHC (c.482G > A; p.Arg161Gln) and another splicing variant in PRDX1 (c.1-515G > T) that cause the silencing of the wild-type MMACHC allele, so confirming the diagnosis of cblC defect. Although cblC treatment was effective, when 17-year-old he experienced a relapse of neurological symptoms. Further imaging and laboratory studies eventually supported the diagnosis of MS. DISCUSSION While the comorbid association of MS and cblC in our patient may remain anecdotic, we suggest measuring Hcy and MMA levels in young patients with a relapsing-remitting demyelinating disorder, in order not to miss a cblC defect, that requires a specific and effective treatment.
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20
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Marrie RA, O'Mahony J, Maxwell C, Ling V, Till C, Barlow-Krelina E, Yeh EA, Arnold DL, Bar-Or A, Banwell B. Factors associated with health care utilization in pediatric multiple sclerosis. Mult Scler Relat Disord 2019; 38:101511. [PMID: 31722282 DOI: 10.1016/j.msard.2019.101511] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 11/02/2019] [Accepted: 11/05/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND We assessed whether clinical characteristics and health-related quality of life (HRQOL) are independently associated with subsequent hospitalizations and physician visits among children with multiple sclerosis (MS); and whether differences in HRQOL account for differences in physician visits between children with MS, monophasic acquired demyelinating syndromes (ADS) and healthy children. METHODS We used linked administrative (health) data from Ontario, Canada and data from a prospective cohort study including HRQOL (measured using the PedsQL), age, sex, cognitive function (accuracy and response time as assessed by Penn Neurocognitive Battery), number of relapses, and neurologic abnormalities on examination. We used generalized linear models with generalized estimating equations to examine factors associated with hospitalizations and ambulatory physician visit rates following each HRQOL assessment, adjusting for age, sex, and socioeconomic status. RESULTS We included 36 children with MS, 43 with monophasic ADS and 43 healthy controls. Among children with MS, more relapses were associated with increased odds of hospitalization (odds ratio 1.59; 1.18-2.14); better cognitive accuracy scores were associated with fewer physician visits (rate ratio [RR] 0.68; 0.47-0.98). Children with MS had higher rates of physician visits than healthy children (RR 1.44; 1.00-2.08), unlike children with a monophasic ADS, but HRQOL scores did not account for these differences. CONCLUSION Within the MS population, more relapses are associated with increased odds of hospitalization while better cognitive performance is associated with reduced rates of physician visits. Differences in HRQOL do not account for differences in physician visits by children with MS as compared to healthy children.
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Affiliation(s)
- Ruth Ann Marrie
- Departments of Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Julia O'Mahony
- Institute of Health Policy, Management and Evaluation, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Colleen Maxwell
- Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada; ICES, Toronto, Ontario, Canada.
| | | | - Christine Till
- Department of Psychology, York University, Toronto, Ontario, Canada.
| | | | - E Ann Yeh
- Department of Pediatrics, University of Toronto; Division of Neurology, The Hospital for Sick Children, Neurosciences and Mental Health, SickKids Research Institute, Toronto, Ontario, Canada.
| | - Douglas L Arnold
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
| | - Amit Bar-Or
- Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Brenda Banwell
- Division of Child Neurology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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21
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Krupp LB, Vieira MC, Toledano H, Peneva D, Druyts E, Wu P, Boulos FC. A Review of Available Treatments, Clinical Evidence, and Guidelines for Diagnosis and Treatment of Pediatric Multiple Sclerosis in the United States. J Child Neurol 2019; 34:612-620. [PMID: 31234708 DOI: 10.1177/0883073819855592] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pediatric multiple sclerosis is associated with challenges in prompt diagnosis and uncertainty regarding optimal treatment. This review aimed to identify treatment guidelines or consensus statements for pediatric patients with multiple sclerosis, US Food and Drug Administration (FDA)-approved treatment options for pediatric multiple sclerosis, and any randomized controlled trials and observational studies examining available pharmacologic treatments in the pediatric multiple sclerosis population. Literature searches were performed in MEDLINE (1946-2016), EMBASE (1974-2016), and the Cochrane Central Register of Controlled Trials to identify treatment guidelines or consensus statements, pediatric multiple sclerosis treatment approvals, and randomized controlled trials and observation studies that examine the safety and effectiveness of available disease-modifying therapies. Only 3 consensus statements provided recommendations for pharmacologic treatments for children, all 3 published before the most recent revisions of the pediatric multiple sclerosis diagnostic guidelines. Despite the changes to the clinical landscape of pediatric multiple sclerosis with the introduction of diagnostic guidelines, fingolimod is the only FDA-approved treatment for pediatric multiple sclerosis in the United States. The effectiveness and safety of other disease-modifying therapies suggested by consensus statements have been reported in relatively small prospective and retrospective observational studies. Clinical evidence from a recently completed randomized controlled trial and future global registries can inform treatment decisions for the pediatric multiple sclerosis population.
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Affiliation(s)
| | | | - Haley Toledano
- 2 Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Desi Peneva
- 3 Precision Health Economics, Los Angeles, CA, USA
| | | | - Ping Wu
- 4 Precision Xtract, Vancouver, BC, USA
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Hebert D, Geisthardt C, Hoffman H. Insights and Recommendations From Parents Receiving a Diagnosis of Pediatric Multiple Sclerosis for Their Child. J Child Neurol 2019; 34:464-471. [PMID: 31012369 DOI: 10.1177/0883073819842420] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Forty-two parents of 41 children reported on their experiences receiving a diagnosis of pediatric-onset multiple sclerosis for their child through semistructured phone interviews. Time to diagnosis ranged from 8 hours to 16 years, with the mean age at diagnosis of 13.7 years. The most common initial symptoms included visual disturbances and numbness. The mean number of medical visits to receive a diagnosis was 3.6. Parents reported feeling frustrated and overwhelmed during the diagnosis process, as well as shocked when told their child had multiple sclerosis. Parents emphasized the need for more awareness of pediatric-onset multiple sclerosis. Numerous parents reported encountering physicians who believed multiple sclerosis did not occur in childhood, contributing to a longer time to diagnosis. Parents preferred physicians first share the diagnosis with the parents without the child present. Finally, parents appreciated when physicians provided a variety of resources to help them cope with the diagnosis.
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Affiliation(s)
- Danielle Hebert
- 1 Central Michigan University College of Medicine, Mount Pleasant, MI, USA
| | - Cheryl Geisthardt
- 2 College of Education and Human Services, Central Michigan University, Mount Pleasant, MI, USA
| | - Holly Hoffman
- 2 College of Education and Human Services, Central Michigan University, Mount Pleasant, MI, USA
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23
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Wallin MT, Culpepper WJ, Campbell JD, Nelson LM, Langer-Gould A, Marrie RA, Cutter GR, Kaye WE, Wagner L, Tremlett H, Buka SL, Dilokthornsakul P, Topol B, Chen LH, LaRocca NG. The prevalence of MS in the United States: A population-based estimate using health claims data. Neurology 2019; 92:e1029-e1040. [PMID: 30770430 PMCID: PMC6442006 DOI: 10.1212/wnl.0000000000007035] [Citation(s) in RCA: 690] [Impact Index Per Article: 138.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 08/17/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To generate a national multiple sclerosis (MS) prevalence estimate for the United States by applying a validated algorithm to multiple administrative health claims (AHC) datasets. METHODS A validated algorithm was applied to private, military, and public AHC datasets to identify adult cases of MS between 2008 and 2010. In each dataset, we determined the 3-year cumulative prevalence overall and stratified by age, sex, and census region. We applied insurance-specific and stratum-specific estimates to the 2010 US Census data and pooled the findings to calculate the 2010 prevalence of MS in the United States cumulated over 3 years. We also estimated the 2010 prevalence cumulated over 10 years using 2 models and extrapolated our estimate to 2017. RESULTS The estimated 2010 prevalence of MS in the US adult population cumulated over 10 years was 309.2 per 100,000 (95% confidence interval [CI] 308.1-310.1), representing 727,344 cases. During the same time period, the MS prevalence was 450.1 per 100,000 (95% CI 448.1-451.6) for women and 159.7 (95% CI 158.7-160.6) for men (female:male ratio 2.8). The estimated 2010 prevalence of MS was highest in the 55- to 64-year age group. A US north-south decreasing prevalence gradient was identified. The estimated MS prevalence is also presented for 2017. CONCLUSION The estimated US national MS prevalence for 2010 is the highest reported to date and provides evidence that the north-south gradient persists. Our rigorous algorithm-based approach to estimating prevalence is efficient and has the potential to be used for other chronic neurologic conditions.
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Affiliation(s)
- Mitchell T Wallin
- From the Department of Veterans Affairs Multiple Sclerosis Center of Excellence (M.T.W., W.J.C.); Georgetown University School of Medicine (M.T.W.), Washington, DC; University of Maryland (W.J.C.), Baltimore; University of Colorado (J.D.C., P.D.), Aurora; Stanford University School of Medicine (L.M.N., B.T.), CA; Southern California Permanente Medical Group (A.L.-G., L.H.C.), Pasadena; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; University of Alabama at Birmingham (G.R.C.); McKing Consulting Corp (W.E.K., L.W.), Atlanta, GA; Faculty of Medicine (Neurology) and Centre for Brain Health (H.T.), University of British Columbia, Vancouver, Canada; Brown University (S.L.B.), Providence, RI; and National Multiple Sclerosis Society (N.G.L.), New York, NY.
| | - William J Culpepper
- From the Department of Veterans Affairs Multiple Sclerosis Center of Excellence (M.T.W., W.J.C.); Georgetown University School of Medicine (M.T.W.), Washington, DC; University of Maryland (W.J.C.), Baltimore; University of Colorado (J.D.C., P.D.), Aurora; Stanford University School of Medicine (L.M.N., B.T.), CA; Southern California Permanente Medical Group (A.L.-G., L.H.C.), Pasadena; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; University of Alabama at Birmingham (G.R.C.); McKing Consulting Corp (W.E.K., L.W.), Atlanta, GA; Faculty of Medicine (Neurology) and Centre for Brain Health (H.T.), University of British Columbia, Vancouver, Canada; Brown University (S.L.B.), Providence, RI; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Jonathan D Campbell
- From the Department of Veterans Affairs Multiple Sclerosis Center of Excellence (M.T.W., W.J.C.); Georgetown University School of Medicine (M.T.W.), Washington, DC; University of Maryland (W.J.C.), Baltimore; University of Colorado (J.D.C., P.D.), Aurora; Stanford University School of Medicine (L.M.N., B.T.), CA; Southern California Permanente Medical Group (A.L.-G., L.H.C.), Pasadena; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; University of Alabama at Birmingham (G.R.C.); McKing Consulting Corp (W.E.K., L.W.), Atlanta, GA; Faculty of Medicine (Neurology) and Centre for Brain Health (H.T.), University of British Columbia, Vancouver, Canada; Brown University (S.L.B.), Providence, RI; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Lorene M Nelson
- From the Department of Veterans Affairs Multiple Sclerosis Center of Excellence (M.T.W., W.J.C.); Georgetown University School of Medicine (M.T.W.), Washington, DC; University of Maryland (W.J.C.), Baltimore; University of Colorado (J.D.C., P.D.), Aurora; Stanford University School of Medicine (L.M.N., B.T.), CA; Southern California Permanente Medical Group (A.L.-G., L.H.C.), Pasadena; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; University of Alabama at Birmingham (G.R.C.); McKing Consulting Corp (W.E.K., L.W.), Atlanta, GA; Faculty of Medicine (Neurology) and Centre for Brain Health (H.T.), University of British Columbia, Vancouver, Canada; Brown University (S.L.B.), Providence, RI; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Annette Langer-Gould
- From the Department of Veterans Affairs Multiple Sclerosis Center of Excellence (M.T.W., W.J.C.); Georgetown University School of Medicine (M.T.W.), Washington, DC; University of Maryland (W.J.C.), Baltimore; University of Colorado (J.D.C., P.D.), Aurora; Stanford University School of Medicine (L.M.N., B.T.), CA; Southern California Permanente Medical Group (A.L.-G., L.H.C.), Pasadena; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; University of Alabama at Birmingham (G.R.C.); McKing Consulting Corp (W.E.K., L.W.), Atlanta, GA; Faculty of Medicine (Neurology) and Centre for Brain Health (H.T.), University of British Columbia, Vancouver, Canada; Brown University (S.L.B.), Providence, RI; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Ruth Ann Marrie
- From the Department of Veterans Affairs Multiple Sclerosis Center of Excellence (M.T.W., W.J.C.); Georgetown University School of Medicine (M.T.W.), Washington, DC; University of Maryland (W.J.C.), Baltimore; University of Colorado (J.D.C., P.D.), Aurora; Stanford University School of Medicine (L.M.N., B.T.), CA; Southern California Permanente Medical Group (A.L.-G., L.H.C.), Pasadena; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; University of Alabama at Birmingham (G.R.C.); McKing Consulting Corp (W.E.K., L.W.), Atlanta, GA; Faculty of Medicine (Neurology) and Centre for Brain Health (H.T.), University of British Columbia, Vancouver, Canada; Brown University (S.L.B.), Providence, RI; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Gary R Cutter
- From the Department of Veterans Affairs Multiple Sclerosis Center of Excellence (M.T.W., W.J.C.); Georgetown University School of Medicine (M.T.W.), Washington, DC; University of Maryland (W.J.C.), Baltimore; University of Colorado (J.D.C., P.D.), Aurora; Stanford University School of Medicine (L.M.N., B.T.), CA; Southern California Permanente Medical Group (A.L.-G., L.H.C.), Pasadena; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; University of Alabama at Birmingham (G.R.C.); McKing Consulting Corp (W.E.K., L.W.), Atlanta, GA; Faculty of Medicine (Neurology) and Centre for Brain Health (H.T.), University of British Columbia, Vancouver, Canada; Brown University (S.L.B.), Providence, RI; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Wendy E Kaye
- From the Department of Veterans Affairs Multiple Sclerosis Center of Excellence (M.T.W., W.J.C.); Georgetown University School of Medicine (M.T.W.), Washington, DC; University of Maryland (W.J.C.), Baltimore; University of Colorado (J.D.C., P.D.), Aurora; Stanford University School of Medicine (L.M.N., B.T.), CA; Southern California Permanente Medical Group (A.L.-G., L.H.C.), Pasadena; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; University of Alabama at Birmingham (G.R.C.); McKing Consulting Corp (W.E.K., L.W.), Atlanta, GA; Faculty of Medicine (Neurology) and Centre for Brain Health (H.T.), University of British Columbia, Vancouver, Canada; Brown University (S.L.B.), Providence, RI; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Laurie Wagner
- From the Department of Veterans Affairs Multiple Sclerosis Center of Excellence (M.T.W., W.J.C.); Georgetown University School of Medicine (M.T.W.), Washington, DC; University of Maryland (W.J.C.), Baltimore; University of Colorado (J.D.C., P.D.), Aurora; Stanford University School of Medicine (L.M.N., B.T.), CA; Southern California Permanente Medical Group (A.L.-G., L.H.C.), Pasadena; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; University of Alabama at Birmingham (G.R.C.); McKing Consulting Corp (W.E.K., L.W.), Atlanta, GA; Faculty of Medicine (Neurology) and Centre for Brain Health (H.T.), University of British Columbia, Vancouver, Canada; Brown University (S.L.B.), Providence, RI; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Helen Tremlett
- From the Department of Veterans Affairs Multiple Sclerosis Center of Excellence (M.T.W., W.J.C.); Georgetown University School of Medicine (M.T.W.), Washington, DC; University of Maryland (W.J.C.), Baltimore; University of Colorado (J.D.C., P.D.), Aurora; Stanford University School of Medicine (L.M.N., B.T.), CA; Southern California Permanente Medical Group (A.L.-G., L.H.C.), Pasadena; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; University of Alabama at Birmingham (G.R.C.); McKing Consulting Corp (W.E.K., L.W.), Atlanta, GA; Faculty of Medicine (Neurology) and Centre for Brain Health (H.T.), University of British Columbia, Vancouver, Canada; Brown University (S.L.B.), Providence, RI; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Stephen L Buka
- From the Department of Veterans Affairs Multiple Sclerosis Center of Excellence (M.T.W., W.J.C.); Georgetown University School of Medicine (M.T.W.), Washington, DC; University of Maryland (W.J.C.), Baltimore; University of Colorado (J.D.C., P.D.), Aurora; Stanford University School of Medicine (L.M.N., B.T.), CA; Southern California Permanente Medical Group (A.L.-G., L.H.C.), Pasadena; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; University of Alabama at Birmingham (G.R.C.); McKing Consulting Corp (W.E.K., L.W.), Atlanta, GA; Faculty of Medicine (Neurology) and Centre for Brain Health (H.T.), University of British Columbia, Vancouver, Canada; Brown University (S.L.B.), Providence, RI; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Piyameth Dilokthornsakul
- From the Department of Veterans Affairs Multiple Sclerosis Center of Excellence (M.T.W., W.J.C.); Georgetown University School of Medicine (M.T.W.), Washington, DC; University of Maryland (W.J.C.), Baltimore; University of Colorado (J.D.C., P.D.), Aurora; Stanford University School of Medicine (L.M.N., B.T.), CA; Southern California Permanente Medical Group (A.L.-G., L.H.C.), Pasadena; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; University of Alabama at Birmingham (G.R.C.); McKing Consulting Corp (W.E.K., L.W.), Atlanta, GA; Faculty of Medicine (Neurology) and Centre for Brain Health (H.T.), University of British Columbia, Vancouver, Canada; Brown University (S.L.B.), Providence, RI; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Barbara Topol
- From the Department of Veterans Affairs Multiple Sclerosis Center of Excellence (M.T.W., W.J.C.); Georgetown University School of Medicine (M.T.W.), Washington, DC; University of Maryland (W.J.C.), Baltimore; University of Colorado (J.D.C., P.D.), Aurora; Stanford University School of Medicine (L.M.N., B.T.), CA; Southern California Permanente Medical Group (A.L.-G., L.H.C.), Pasadena; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; University of Alabama at Birmingham (G.R.C.); McKing Consulting Corp (W.E.K., L.W.), Atlanta, GA; Faculty of Medicine (Neurology) and Centre for Brain Health (H.T.), University of British Columbia, Vancouver, Canada; Brown University (S.L.B.), Providence, RI; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Lie H Chen
- From the Department of Veterans Affairs Multiple Sclerosis Center of Excellence (M.T.W., W.J.C.); Georgetown University School of Medicine (M.T.W.), Washington, DC; University of Maryland (W.J.C.), Baltimore; University of Colorado (J.D.C., P.D.), Aurora; Stanford University School of Medicine (L.M.N., B.T.), CA; Southern California Permanente Medical Group (A.L.-G., L.H.C.), Pasadena; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; University of Alabama at Birmingham (G.R.C.); McKing Consulting Corp (W.E.K., L.W.), Atlanta, GA; Faculty of Medicine (Neurology) and Centre for Brain Health (H.T.), University of British Columbia, Vancouver, Canada; Brown University (S.L.B.), Providence, RI; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Nicholas G LaRocca
- From the Department of Veterans Affairs Multiple Sclerosis Center of Excellence (M.T.W., W.J.C.); Georgetown University School of Medicine (M.T.W.), Washington, DC; University of Maryland (W.J.C.), Baltimore; University of Colorado (J.D.C., P.D.), Aurora; Stanford University School of Medicine (L.M.N., B.T.), CA; Southern California Permanente Medical Group (A.L.-G., L.H.C.), Pasadena; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; University of Alabama at Birmingham (G.R.C.); McKing Consulting Corp (W.E.K., L.W.), Atlanta, GA; Faculty of Medicine (Neurology) and Centre for Brain Health (H.T.), University of British Columbia, Vancouver, Canada; Brown University (S.L.B.), Providence, RI; and National Multiple Sclerosis Society (N.G.L.), New York, NY
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Wijnands JMA, Ekuma O, Kingwell E, Zhu F, Zhao Y, Fisk JD, Evans C, Tremlett H, Marrie RA. MRI utilization during the diagnostic and post-diagnostic phases in multiple sclerosis. Mult Scler Relat Disord 2018; 28:138-144. [PMID: 30594814 DOI: 10.1016/j.msard.2018.12.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/21/2018] [Accepted: 12/21/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) plays an important role in the diagnosis and monitoring of people with multiple sclerosis (MS). MRI rates in MS populations are poorly understood. Although Canada has universal health care, socioeconomic status (SES) is associated with MRI use. It is unknown if such disparities persist for specific conditions such as MS when care is managed centrally, or how disease-specific characteristics may affect MRI use. OBJECTIVE To assess magnetic resonance imaging (MRI) use in MS and control participants and its association with participant characteristics. METHODS Using administrative and clinical data from Manitoba, Canada, we assessed MRI use in MS and control participants during the five years pre-index (first demyelinating claim in the administrative cohort or symptom onset in the clinical cohort), between index and diagnosis (third demyelinating claim in the administrative cohort or diagnosis date in the clinical cohort), and the five years post-diagnosis. Using zero-inflated Poisson regression, we assessed associations between participant characteristics and index year, and MRI use during these three phases. RESULTS We included 2,763 MS cases and 13,815 controls in the administrative cohort, and 961 MS cases in the clinical cohort. MRI use increased over time, but more in cases than in controls. Pre-index, individuals aged <50 years at the index date had lower MRI rates than those aged ≥50 years. Sex, socioeconomic status and region were not associated with MRI use. Disease-modifying therapy use was associated with 25% more MRIs post-diagnosis (adjusted rate ratio: 1.25; 95%CI:1.09-1.43) in the clinical cohort. CONCLUSION Our findings suggest equity of access to MRI across sex, region and socioeconomic status in MS.
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Affiliation(s)
- José M A Wijnands
- Medicine (Neurology), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - Okechukwu Ekuma
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada.
| | - Elaine Kingwell
- Medicine (Neurology), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - Feng Zhu
- Medicine (Neurology), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - Yinshan Zhao
- Medicine (Neurology), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - John D Fisk
- Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, 4066 A.J. Lane Memorial Building, 5909 Veterans' Memorial Lane, Halifax, NS, B3H 2E2, Canada.
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, 3130 Health Sciences Bldg, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada.
| | - Helen Tremlett
- Medicine (Neurology), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Health Sciences Centre, GF543, 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada.
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Ghezzi A. Pediatric multiple sclerosis: epidemiology, clinical aspects, diagnosis and treatment. Neurodegener Dis Manag 2018; 7:23-25. [PMID: 29143584 DOI: 10.2217/nmt-2017-0037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Angelo Ghezzi
- Centro Studi Sclerosi Multipla, Ospedale di Gallarate, Via Pastori 4, 21013, Gallarate, Italy
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Marrie RA, O'Mahony J, Maxwell C, Ling V, Yeh EA, Arnold DL, Bar-Or A, Banwell B. Incidence and prevalence of MS in children. Neurology 2018; 91:e1579-e1590. [DOI: 10.1212/wnl.0000000000006395] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/16/2018] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo validate a case definition of multiple sclerosis (MS) in the pediatric population using administrative (health claims) data, and to estimate the incidence and prevalence of MS in the pediatric population for Ontario, Canada.MethodsWe used population-based administrative data to identify persons aged ≤18 years with MS. We assessed the performance of multiple administrative case definitions using a clinical reference cohort including children with MS, children with monophasic demyelinating syndromes, and healthy children; we report sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). We applied 2 preferred case definitions to estimate the incidence and prevalence of MS from 2003 to 2014.ResultsThe Canadian Chronic Disease Surveillance System definition of ≥1 hospitalization or ≥5 physician claims for MS within 2 years had a sensitivity of 81.1%, specificity of 100%, PPV of 100%, and NPV of 86%. The Marrie definition of ≥3 hospital or physician claims for MS ever had a sensitivity of 89.2%, specificity of 100%, PPV of 100%, and NPV of 91.5%. Depending on the administrative case definition used, in 2014, the annual age-standardized annual incidence of MS in the pediatric population ranged from 0.99 to 1.24 per 100,000 population, and the age-standardized prevalence ranged from 4.03 to 6.8 per 100,000 population. The prevalence of MS rose over time.ConclusionAdministrative data provide a feasible, valid means of estimating the incidence and prevalence of MS in the pediatric population. MS prevalence in the Ontario pediatric population is among the highest reported in pediatric populations worldwide.
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Magalhaes S, Banwell B, Bar-Or A, Fortier I, Hanwell HE, Lim M, Matt GE, Neuteboom RF, O'Riordan DL, Schneider PK, Pugliatti M, Shatenstein B, Tansey CM, Wassmer E, Wolfson C. A framework for measurement and harmonization of pediatric multiple sclerosis etiologic research studies: The Pediatric MS Tool-Kit. Mult Scler 2018; 25:1170-1177. [PMID: 29932341 PMCID: PMC6572633 DOI: 10.1177/1352458518783345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: While studying the etiology of multiple sclerosis (MS) in children has several methodological advantages over studying etiology in adults, studies are limited by small sample sizes. Objective: Using a rigorous methodological process, we developed the Pediatric MS Tool-Kit, a measurement framework that includes a minimal set of core variables to assess etiological risk factors. Methods: We solicited input from the International Pediatric MS Study Group to select three risk factors: environmental tobacco smoke (ETS) exposure, sun exposure, and vitamin D intake. To develop the Tool-Kit, we used a Delphi study involving a working group of epidemiologists, neurologists, and content experts from North America and Europe. Results: The Tool-Kit includes six core variables to measure ETS, six to measure sun exposure, and six to measure vitamin D intake. The Tool-Kit can be accessed online (www.maelstrom-research.org/mica/network/tool-kit). Conclusion: The goals of the Tool-Kit are to enhance exposure measurement in newly designed pediatric MS studies and comparability of results across studies, and in the longer term to facilitate harmonization of studies, a methodological approach that can be used to circumvent issues of small sample sizes. We believe the Tool-Kit will prove to be a valuable resource to guide pediatric MS researchers in developing study-specific questionnaire
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Affiliation(s)
- Sandra Magalhaes
- Royal Victoria Hospital, Allan Memorial Institute and Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC, Canada/Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Brenda Banwell
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Amit Bar-Or
- Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Isabel Fortier
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Heather E Hanwell
- Dalla Lana School of Public Health, The University of Toronto, Toronto, ON, Canada
| | - Ming Lim
- Children's Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundations Trust, King's Health Partners Academic Health Sciences Centre, London, UK/ Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Georg E Matt
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Rinze F Neuteboom
- Department of Pediatric Neurology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - David L O'Riordan
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Paul K Schneider
- Royal Victoria Hospital, Allan Memorial Institute and Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Maura Pugliatti
- Department of Medicine, McGill University, Montreal, QC, Canada/ Unit of Clinical Neurology, Department of Biomedical and Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Bryna Shatenstein
- Département de nutrition, Université de Montréal, Montreal, QC, Canada/ Centre de recherche, Institut universitaire de gériatrie de Montréal, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Catherine M Tansey
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | | | - Christina Wolfson
- Royal Victoria Hospital, Allan Memorial Institute and Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC, Canada/ Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada/ Department of Medicine, McGill University, Montreal, QC, Canada
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