Characteristics of pediatric multiple sclerosis: A tertiary referral center study

Pediatric onset multiple sclerosis in Kuwait

BACKGROUND

Epidemiological data of pediatric-onset multiple sclerosis (POMS) in the Middle East is limited.

OBJECTIVE

To determine the demographic and clinical characteristics of POMS in Kuwait.

METHODS

A retrospective study was conducted to assess the clinical characteristics of multiple sclerosis (MS) patients who disease onset started at age < 18 years and fulfilled the International Pediatric MS Study Group (IPMSSG) criteria for MS.

RESULTS

Of 249 POMS who were assessed, 70.3 % were female. The mean age at onset was 15.06 +11.78 years. Brainstem / cerebellar manifestation (34.9 %) were the most frequent presentation at onset of disease, followed by spinal (29.3 %) and visual pathway (27.3 %) symptoms. At the last follow-up visits, most of the patients (83.5 %) remained in a relapsing-remitting phenotype. The annual relapse rate (ARR) was 0.18 throughout the first 2 years while on treatment. At the baseline visit, the 51.4 % of the cohort-initiated platform therapies. Breakthrough disease (36.1 %) and adverse events (9.6 %) were the most common indications to escalate or switch to other disease-modifying drugs (DMTs).

CONCLUSION

Most POMS patients continued to be in a relapsing phenotype in our longitudinal study. Disease breakthrough is common in POMS especially when using platform therapies.

Interim guidelines for the assessment and treatment of pain in children with multiple sclerosis

Introduction

Pain in multiple sclerosis (MS) is common, but literature on pain in children with MS remains scarce. Pain has physical, psychological, and social implications in MS, and both comprehensive assessment and interdisciplinary management approaches are needed. We sought to develop an interdisciplinary interim guideline for the assessment and management of pain in children with MS.

Methods and materials

We convened a modified Delphi panel composed of 13 experts in pediatric and adult MS neurology, physiotherapy, pain, patient lived-experience, advanced practice nursing, psychology, physiatry, and MS research. A survey was sent to panelists for anonymous completion. The panel discussed survey themes extracted by the panel chair. The process was repeated twice.

Results

Thirteen assessment and treatment recommendations were produced regarding pain in children with MS.

Discussion

Future studies will assess implementation of these pain assessment and treatment guidelines in the clinical setting.

Hearing abnormalities in multiple sclerosis: clinical semiology and pathophysiologic mechanisms

Auditory manifestations from multiple sclerosis (MS) are not as common as the well-recognized sentinel exacerbations of optic neuritis, partial myelitis, motor weakness, vertiginous episodes, heat intolerance, and eye movement abnormalities. This paper discusses four cases of auditory changes, secondary to MS, and describes the first case, to our knowledge, of palinacousis, the perseveration of hearing, despite cessation of the sound stimulus. For each we characterize the initial complaint, the diagnostic work up, and ultimately, underscore the individualized treatment interventions, that allowed us to achieve a remission in all four cases. Individually codifying the treatment regimens served to mitigate, if not to abolish, the clinical derangements in hearing. Special attention is focused upon examination of the clinical manifestations and the pathophysiologic mechanisms which are responsible for them. We further emphasize the differential diagnostic considerations, and physical exam findings, along with the results of laboratory testing, neuro-imaging sequences, and lesion localization. Taken together, such information is germane to organizing cogently coherent strategic treatment plan(s). We believe that this small case series represents a clinically pragmatic example of 'precision medicine'; a principal theme and goal throughout this paper, the achievement of such in MS, but also as an illustration for the assessment and management schema for neuroimmunologic disorders in general.

The Role of Pediatric Rheumatologists in Autoimmune Brain Disease

The spectrum of autoimmune and inflammatory brain diseases continues to evolve with medical advances facilitating both the detection of inflammation of the central nervous system and the discovery of novel disease mechanisms. The clinical overlap of these disorders with primary rheumatic diseases and the efficacy of immunotherapy have led to strong partnerships between pediatric rheumatologists, neurologists, psychiatrists, and other providers in the care of children with these conditions. Early diagnosis and initiation of targeted therapy improve clinical outcomes, highlighting the importance of interdisciplinary collaborative care.