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Sadovnick D, Criscuoli M, Yee I, Carruthers R, Schabas A, Devonshire V, Smyth P. The Canadian Multiple Sclerosis Pregnancy Study: First-trimester miscarriages in women with multiple sclerosis. Mult Scler 2023; 29:407-414. [PMID: 36683353 DOI: 10.1177/13524585221146270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND There is increasing need for evidence-based data on reproduction for women with multiple sclerosis (MS). First-trimester (first 13 weeks) miscarriages are relatively common in the general population. It is therefore important to have information on the frequency with which this occurs in women with MS. METHODS The Canadian Multiple Sclerosis Pregnancy Study (CANPREG-MS) is a prospective study on women with MS who are pregnant or actively trying to conceive. As far as we are aware, this is the first study on miscarriages for this population that takes into account each woman's entire pregnancy history (i.e. before and after the MS diagnosis as well as during enrollment in CANPREG-MS). RESULTS There were 208 pregnancies during the study and 36 resulted in first-trimester miscarriage for a rate of 17.31%, within the expected range of 15%-20% for the general population. CONCLUSIONS CANPREG-MS provides real world data that there does not appear to be an increase in first-trimester miscarriages for women with MS. This information will be helpful to women with MS and their healthcare providers.
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Affiliation(s)
- Dessa Sadovnick
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada/Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Maria Criscuoli
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Irene Yee
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Robert Carruthers
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alice Schabas
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Virginia Devonshire
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Penelope Smyth
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Sadovnick D, Criscuoli M, Yee I, Carruthers R, Schabas A, Smyth P. The road to conception for women with multiple sclerosis. Mult Scler J Exp Transl Clin 2021; 7:20552173211032313. [PMID: 34350028 PMCID: PMC8287372 DOI: 10.1177/20552173211032313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/25/2021] [Indexed: 11/30/2022] Open
Abstract
Objective The objective of this prospective “real world” study is to gain insight into
the different “roads to conception” that women with MS take as part of the
prospective Canadian Multiple Sclerosis Pregnancy Study (CANPREG-MS). Methods Participants are women with MS who are planning a pregnancy. Data cut-off for
analyses was April 30, 2020. Results We believe this is the first prospective National study of women with MS
planning pregnancies. The data are for the first 44 women enrolled of whom 26 achieved pregnancy by
cut-off date. Seven women used assisted reproductive technologies (ARTs); 6
stopped disease modifying therapy (DMT) against their neurologists’
recommendations; 6 had an interruption(s) in trying to conceive due to MS
relapses, MRI-detected inflammation, or limited “windows of opportunity”
between DMT courses. Conclusion The study illustrates the roads that women take to conception, even if they
are on the same therapy and have similar clinical expression of MS. Advice
given by treating neurologists on washout periods show discrepancies. This
paper highlights the real problem that there is no definitive, international
consensus on managing these women due to the lack of “real world” data and
thus the goal of CANPREG-MS is to provide such real world data.
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Affiliation(s)
- Dessa Sadovnick
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Maria Criscuoli
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada
| | - Irene Yee
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Robert Carruthers
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada
| | - Alice Schabas
- Faculty of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Penelope Smyth
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada
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Mexhitaj I, Nyirenda MH, Li R, O'Mahony J, Rezk A, Rozenberg A, Moore CS, Johnson T, Sadovnick D, Collins DL, Arnold DL, Gran B, Yeh EA, Marrie RA, Banwell B, Bar-Or A. Abnormal effector and regulatory T cell subsets in paediatric-onset multiple sclerosis. Brain 2020; 142:617-632. [PMID: 30759186 DOI: 10.1093/brain/awz017] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 12/05/2018] [Accepted: 12/31/2018] [Indexed: 12/13/2022] Open
Abstract
Elucidation of distinct T-cell subsets involved in multiple sclerosis immune-pathophysiology continues to be of considerable interest since an ultimate goal is to more selectively target the aberrant immune response operating in individual patients. While abnormalities of both effector (Teff) and regulatory (Treg) T cells have been reported in patients with multiple sclerosis, prior studies have mostly assessed average abnormalities in either limb of the immune response, rather than both at the same time, which limits the ability to evaluate the balance between effectors and regulators operating in the same patient. Assessing both phenotypic and functional responses of Teffs and Tregs has also proven important. In studies of adults with multiple sclerosis, in whom biological disease onset likely started many years prior to the immune assessments, an added challenge for any reported abnormality is whether the abnormality indeed contributes to the disease (and hence of interest to target therapeutically) or merely develops consequent to inflammatory injury (in which case efforts to develop targeted therapies are unlikely to be beneficial). Paediatric-onset multiple sclerosis, though rare, offers a unique window into early disease mechanisms. Here, we carried out a comprehensive integrated study, simultaneously assessing phenotype and functional responses of both effector and regulatory T cells in the same children with multiple sclerosis, monophasic inflammatory CNS disorders, and healthy controls, recruited as part of the multicentre prospective Canadian Pediatric Demyelinating Disease Study (CPDDS). Stringent standard operating procedures were developed and uniformly applied to procure, process and subsequently analyse peripheral blood cells using rigorously applied multi-parametric flow cytometry panels and miniaturized functional assays validated for use with cryopreserved cells. We found abnormally increased frequencies and exaggerated pro-inflammatory responses of CD8+CD161highTCR-Vα7.2+ MAIT T cells and CD4+CCR2+CCR5+ Teffs in paediatric-onset multiple sclerosis, compared to both control groups. CD4+CD25hiCD127lowFOXP3+ Tregs of children with multiple sclerosis exhibited deficient suppressive capacity, including diminished capacity to suppress disease-implicated Teffs. In turn, the implicated Teffs of multiple sclerosis patients were relatively resistant to suppression by normal Tregs. An abnormal Teff/Treg ratio at the individual child level best distinguished multiple sclerosis children from controls. We implicate abnormalities in both frequencies and functional responses of distinct pro-inflammatory CD4 and CD8 T cell subsets, as well as Treg function, in paediatric-onset multiple sclerosis, and suggest that mechanisms contributing to early multiple sclerosis development differ across individuals, reflecting an excess abnormality in either Teff or Treg limbs of the T cell response, or a combination of lesser abnormalities in both limbs.
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Affiliation(s)
- Ina Mexhitaj
- Neuroimmunology Unit, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 3801 University Street, Suite # 111, Montreal, Quebec, Canada.,Center for Neuroinflammation and Experimental Therapeutics and the Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, USA
| | - Mukanthu H Nyirenda
- Neuroimmunology Unit, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 3801 University Street, Suite # 111, Montreal, Quebec, Canada
| | - Rui Li
- Neuroimmunology Unit, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 3801 University Street, Suite # 111, Montreal, Quebec, Canada.,Center for Neuroinflammation and Experimental Therapeutics and the Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, USA
| | - Julia O'Mahony
- Division of Neurology, Department of Paediatrics, SickKids Research Institute, Neurosciences and Mental Health, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada
| | - Ayman Rezk
- Neuroimmunology Unit, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 3801 University Street, Suite # 111, Montreal, Quebec, Canada.,Center for Neuroinflammation and Experimental Therapeutics and the Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, USA
| | - Ayal Rozenberg
- Neuroimmunology Unit, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 3801 University Street, Suite # 111, Montreal, Quebec, Canada
| | - Craig S Moore
- Neuroimmunology Unit, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 3801 University Street, Suite # 111, Montreal, Quebec, Canada
| | - Trina Johnson
- Experimental Therapeutics Program, Montreal Neurological Institute, McGill University, 3801 University Street, Montreal, Quebec, Canada
| | - Dessa Sadovnick
- Department of Medical Genetics and Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - D Louis Collins
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, 3801 University Street, Montreal, Quebec, Canada
| | - Douglas L Arnold
- Neuroimmunology Unit, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 3801 University Street, Suite # 111, Montreal, Quebec, Canada
| | - Bruno Gran
- Clinical Neurology Research Group, Division of Clinical Neuroscience, University of Nottingham School of Medicine, Nottingham, UK
| | - E Ann Yeh
- Division of Neurology, Department of Paediatrics, SickKids Research Institute, Neurosciences and Mental Health, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario, 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, 820 Sherbrook Street, Winnipeg, Canada
| | - Brenda Banwell
- Division of Neurology, Department of Paediatrics, SickKids Research Institute, Neurosciences and Mental Health, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada.,Division of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Philadelphia, PA, USA
| | - Amit Bar-Or
- Neuroimmunology Unit, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 3801 University Street, Suite # 111, Montreal, Quebec, Canada.,Center for Neuroinflammation and Experimental Therapeutics and the Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, USA.,Division of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Philadelphia, PA, USA
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Sadovnick D, Bove R, Chitnis T. The role of hormones and gender in MS. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.09.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Nyirenda M, Li R, Moore C, Rozenberg A, Rezk A, Johnson T, Sadovnick D, Arnold D, Marrie RA, Banwell B, Bar-or A. Abnormal responses of CD8+CD161high mucosal associated invariant T (MAIT) cells and CCR2+CCR5+ CD4 T cells contribute to disrupted balance of effector and regulatory T cells in pediatric-onset MS. J Neuroimmunol 2014. [DOI: 10.1016/j.jneuroim.2014.08.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Traboulsee AL, Knox KB, Machan L, Zhao Y, Yee I, Rauscher A, Klass D, Szkup P, Otani R, Kopriva D, Lala S, Li DK, Sadovnick D. Prevalence of extracranial venous narrowing on catheter venography in people with multiple sclerosis, their siblings, and unrelated healthy controls: a blinded, case-control study. Lancet 2014; 383:138-45. [PMID: 24119384 DOI: 10.1016/s0140-6736(13)61747-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Chronic cerebrospinal venous insufficiency has been proposed as a unique combination of extracranial venous blockages and haemodynamic flow abnormalities that occurs only in patients with multiple sclerosis and not in healthy people. Initial reports indicated that all patients with multiple sclerosis had chronic cerebrospinal venous insufficiency. We aimed to establish the prevalence of venous narrowing in people with multiple sclerosis, unaffected full siblings, and unrelated healthy volunteers. METHODS We did an assessor-blinded, case-control, multicentre study of people with multiple sclerosis, unaffected siblings, and unrelated healthy volunteers. We enrolled the study participants between January, 2011 and March, 2012, and they comprised 177 adults: 79 with multiple sclerosis, 55 siblings, and 43 unrelated controls, from three centres in Canada. We assessed narrowing of the internal jugular and azygous veins with catheter venography and ultrasound criteria for chronic cerebrospinal venous insufficiency proposed by Zamboni and colleagues. Catheter venography data were available for 149 participants and ultrasound data for 171 participants. FINDINGS Catheter venography criteria for chronic cerebrospinal venous insufficiency were positive for one of 65 (2%) people with multiple sclerosis, one of 46 (2%) siblings, and one of 32 (3%) unrelated controls (p=1·0 for all comparisons). Greater than 50% narrowing of any major vein was present in 48 of 65 (74%) people with multiple sclerosis, 31 of 47 (66%) siblings (p=0·41 for comparison with patients with multiple sclerosis), and 26 of 37 (70%) unrelated controls (p=0·82). The ultrasound criteria for chronic cerebrospinal venous insufficiency were fulfilled in 35 of 79 (44%) participants with multiple sclerosis, 17 of 54 (31%) siblings (p=0·15 for comparison with patients with multiple sclerosis) and 17 of 38 (45%) unrelated controls (p=0·98). The sensitivity of the ultrasound criteria for detection of greater than 50% narrowing on catheter venography was 0·406 (95% CI 0·311-0·508), and specificity was 0·643 (0·480-0·780). INTERPRETATION This study shows that chronic cerebrospinal venous insufficiency occurs rarely in both patients with multiple sclerosis and in healthy people. Extracranial venous narrowing of greater than 50% is a frequent finding in patients with multiple sclerosis, unaffected siblings, and unrelated controls. The ultrasound criteria are neither sensitive nor specific for narrowing on catheter venography. The significance of venous narrowing to multiple sclerosis symptomatology remains unknown. FUNDING MS Society of Canada, Saskatoon City Hospital Foundation, Lotte and John Hecht Memorial Foundation, Vancouver Coastal Health Foundation, and the Wolridge Foundation.
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Affiliation(s)
| | - Katherine B Knox
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Lindsay Machan
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Yinshan Zhao
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Irene Yee
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Alexander Rauscher
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Darren Klass
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Peter Szkup
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Robert Otani
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - David Kopriva
- Department of Surgery, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Shanti Lala
- Department of Surgery, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - David K Li
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Dessa Sadovnick
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
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Omoumi A, Fok A, Greenwood T, Sadovnick D, Feldman H, Hsiung G. P3–006: Late‐onset Alzheimer's disease genetic risk factors in two Canadian cohorts: CSHA and ACCORD. Alzheimers Dement 2013. [DOI: 10.1016/j.jalz.2013.05.1075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ardeshir Omoumi
- University of British Columbia Vancouver British Columbia Canada
| | - Alice Fok
- University of British Columbia Vancouver British Columbia Canada
| | | | | | - Howard Feldman
- University of British Columbia Hospital Vancouver British Columbia Canada
| | - Ging‐Yuek Hsiung
- University of British Columbia Vancouver British Columbia Canada
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Gauthier S, Jia J, Belleville S, Doudet D, Hsiung G, Labbe A, Li D, Qin W, Rosa‐Neto P, Sadovnick D, Soucy J, Wu L. P1–149: Canada‐China Cohort Study of early‐onset familial Alzheimer's disease. Alzheimers Dement 2013. [DOI: 10.1016/j.jalz.2013.05.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Serge Gauthier
- McGill Centre for Studies in Aging Montreal Quebec Canada
| | - Jianping Jia
- Xuan Wu Hospital of Capital Medical University Beijing China
| | - Sylvie Belleville
- Research Center, Institut Universitaire de Gériatrie de Montréal Montreal Quebec Canada
| | - Doris Doudet
- University of British Columbia Vancouver British Columbia Canada
| | - Ging‐Yuek Hsiung
- University of British Columbia Vancouver British Columbia Canada
| | - A. Labbe
- McGill Department of Biostatistics Montreal Quebec Canada
| | - Dan Li
- Department of Neurology Xuan Wu Hospital, Capital Medical University Beijing China
| | - Wei Qin
- Xuan Wu Hospital Beijing China
| | | | - Dessa Sadovnick
- University of British Columbia Hospital Vancouver British Columbia Canada
| | | | - Liyong Wu
- McGill Center for Studies in Aging Verdun Quebec China
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Lu E, Wang BW, Guimond C, Synnes A, Sadovnick D, Tremlett H. Disease-modifying drugs for multiple sclerosis in pregnancy: a systematic review. Neurology 2012; 79:1130-5. [PMID: 22933738 PMCID: PMC3525300 DOI: 10.1212/wnl.0b013e3182698c64] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 04/19/2012] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To systematically review the literature regarding safety of disease-modifying drug (DMD) use during pregnancy on perinatal and developmental outcomes in offspring of patients with multiple sclerosis (MS). METHODS A PubMed and EMBASE search up to February 2012 was conducted with a manual search of references from relevant articles. Selected studies were evaluated using internationally accepted criteria. RESULTS Fifteen studies identified 761 interferon β-, 97 glatiramer acetate-, and 35 natalizumab-exposed pregnancies. Study quality ranged from poor to good; no study was rated excellent. Small sample sizes limited most studies. Compared with data for unexposed pregnancies, fair- to good-quality prospective cohort studies reported that interferon β exposure was associated with lower mean birth weight, shorter mean birth length, and preterm birth (<37 weeks), but not low birth weight (<2,500 g), cesarean delivery, congenital anomaly (including malformation), or spontaneous abortion. Fewer studies of fair quality were available for glatiramer acetate and natalizumab. Glatiramer acetate exposure was not associated with lower mean birth weight, congenital anomaly, preterm birth, or spontaneous abortion. Natalizumab exposure did not appear to be associated with shorter mean birth length, lower mean birth weight, or lower mean gestational age. No studies examined mitoxantrone or fingolimod exposure. One study of paternal DMD use during conception found no effect on gestational age or birth weight. Few studies examined longer-term developmental outcomes. CONCLUSION Further studies are needed to determine the potential risks associated with preconceptional and in utero DMD exposure in patients with MS. Discontinuation of DMDs before conception is still recommended.
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Affiliation(s)
- Ellen Lu
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Ramagopalan S, Yee I, Byrnes J, Guimond C, Ebers G, Sadovnick D. Term pregnancies and the clinical characteristics of multiple sclerosis: a population based study. J Neurol Neurosurg Psychiatry 2012; 83:793-5. [PMID: 22626946 DOI: 10.1136/jnnp-2012-302848] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Pregnancy has a well documented effect on relapse risk in multiple sclerosis (MS). Prospective studies have reported a significant decline by two-thirds in the rate of relapses during the third trimester of pregnancy and a significant increase by two-thirds during the first 3 months postpartum. However, it is unclear as to whether there are any long term effects on disability. METHODS Data were collated from clinical records and family histories systematically collected from the University of British Columbia MS Clinic. RESULTS Clinical and term pregnancy data were available from 2105 female MS patients. MS patients having children after MS onset took the longest time to reach an Expanded Disability Status Scale (EDSS) score of 6 (mean 22.9 years) and patients having children before MS onset were the quickest (mean 13.2 years). However, these effects were not related to term pregnancy and were fully accounted for by age of MS onset. CONCLUSIONS Pregnancy had no effect on the time to reach an EDSS score 6. As MS predominantly affects women of childbearing age, women with MS can be reassured that term pregnancies do not appear to have any long term effects on disability.
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Verhey L, Branson H, Shroff M, Callen D, Sled J, Narayanan S, Bar-Or A, Sadovnick D, Arnold D, Marrie RA, Banwell B. MRI Features Distinguish Monophasic ADEM from MS: Findings from a Canadian Cohort of Children with Incident CNS Demyelination (S50.002). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s50.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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12
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Lu E, Wang BW, Guimond C, Synnes A, Sadovnick D, Tremlett H. Disease-Modifying Drugs for Multiple Sclerosis in Pregnancy: A Systematic Review (P06.188). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Sadaka Y, Verhey L, Shroff M, Branson H, Arnold D, Narayanan S, Sled J, Bar-Or A, Sadovnick D, McGowan M, Ann Marrie R, Banwell B. 2010 McDonald Criteria for Diagnosing Pediatric Multiple Sclerosis (P01.155). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p01.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Hsiung G, Greenwood T, Fok A, Chen C, Sadovnick D. O3‐01‐02: Genetic predictors of progression of cognitive impairment in Two large Canadian cohorts: CSHA and ACCORD. Alzheimers Dement 2011. [DOI: 10.1016/j.jalz.2011.05.2387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | | | - Alice Fok
- University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Cindy Chen
- University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Dessa Sadovnick
- University of British ColumbiaVancouverBritish ColumbiaCanada
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15
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van der Kop ML, Pearce MS, Dahlgren L, Synnes A, Sadovnick D, Sayao AL, Tremlett H. Neonatal and delivery outcomes in women with multiple sclerosis. Ann Neurol 2011; 70:41-50. [PMID: 21710652 PMCID: PMC3625744 DOI: 10.1002/ana.22483] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 05/09/2011] [Accepted: 05/13/2011] [Indexed: 11/30/2022]
Abstract
Objective To determine (1) whether the risk of adverse neonatal and delivery outcomes differs between mothers with and without multiple sclerosis (MS) and (2) whether risk is differentially associated with clinical factors of MS. Methods This retrospective cohort study analyzed data from the British Columbia (BC) MS Clinics' database and the BC Perinatal Database Registry. Comparisons were made between births to women with MS (n = 432) and to a frequency-matched sample of women without MS (n = 2,975) from 1998 to 2009. Outcomes included gestational age, birth weight, assisted vaginal delivery, and Caesarean section. Clinical factors examined included age at MS onset, disease duration, and disability. Multivariate regression models adjusting for confounding factors were built for each outcome. Results Babies born to MS mothers did not have a significantly different mean gestational age or birth weight compared to babies born to mothers without MS. MS was not significantly associated with assisted vaginal delivery (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.50–1.16; p = 0.20) or Caesarean section (OR, 0.94; 95% CI, 0.69–1.28; p = 0.69). There was a slightly elevated risk of adverse delivery outcomes among MS mothers with greater levels of disability, although findings were not statistically significant. Disease duration and age at MS onset were not significantly associated with adverse outcomes. Interpretation This study provides reassurance to MS patients that maternal MS is generally not associated with adverse neonatal and delivery outcomes. However, the suggestion of an increased risk with greater disability warrants further investigation; these women may require closer monitoring during pregnancy. ANN NEUROL 2011;
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Affiliation(s)
- Mia L van der Kop
- Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
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16
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Banwell B, Bar-Or A, Arnold DL, Sadovnick D, Narayanan S, McGowan M, O'Mahony J, Magalhaes S, Hanwell H, Vieth R, Tellier R, Vincent T, Disanto G, Ebers G, Wambera K, Connolly MB, Yager J, Mah JK, Booth F, Sebire G, Callen D, Meaney B, Dilenge ME, Lortie A, Pohl D, Doja A, Venketaswaran S, Levin S, Macdonald EA, Meek D, Wood E, Lowry N, Buckley D, Yim C, Awuku M, Cooper P, Grand'maison F, Baird JB, Bhan V, Marrie RA. Clinical, environmental, and genetic determinants of multiple sclerosis in children with acute demyelination: a prospective national cohort study. Lancet Neurol 2011; 10:436-45. [PMID: 21459044 DOI: 10.1016/s1474-4422(11)70045-x] [Citation(s) in RCA: 203] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND HLA-DRB1*15 genotype, previous infection with Epstein-Barr virus, and vitamin D insufficiency are susceptibility factors for multiple sclerosis, but whether they act synergistically to increase risk is unknown. We aimed to assess the contributions of these risk factors and the effect of established precursors of multiple sclerosis, such as brain lesions on MRI and oligoclonal bands in CSF at the time of incident demyelination, on development of multiple sclerosis in children. METHODS In our prospective national cohort study, we assessed children who presented with incident CNS demyelination to any of the 16 paediatric health-care facilities or seven regional health-care facilities in Canada. We did univariate and multivariable analyses to assess contributions of HLA-DRB1*15, Epstein-Barr virus, vitamin D status, MRI evidence of brain lesions, and CSF oligoclonal bands as determinants of multiple sclerosis. We used classification and regression tree analyses to generate a risk stratification algorithm for clinical use. FINDINGS Between Sept 1, 2004, and June 30, 2010, we screened 332 children of whom 302 (91%) were eligible and followed-up for a median of 3·14 years (IQR 1·61-4·51). 63 (21%) children were diagnosed with multiple sclerosis after a median of 127 days (99-222). Although the risk of multiple sclerosis was increased with presence of one or more HLA-DRB1*15 alleles (hazard ratio [HR] 2·32, 95% CI 1·25-4·30), reduced serum 25-hydroxyvitamin D concentration (HR per 10 nmol/L decrease 1·11, 1·00-1·25), and previous Epstein-Barr-virus infection (HR 2·04, 0·99-4·20), no interactions between these variables were detected on multivariate analysis. Multiple sclerosis was strongly associated with baseline MRI evidence of one or more brain lesion (HR 37·9, 5·26-273·85) or CSF oligoclonal bands (6·33, 3·35-11·96), suggesting established disease. One patient diagnosed with multiple sclerosis had a normal MRI scan, and therefore sensitivity of an abnormal MRI scan for multiple sclerosis diagnosis was 98·4%. INTERPRETATION Risk of multiple sclerosis in children can be stratified by presence of HLA-DRB1*15 alleles, remote Epstein-Barr virus infection, and low serum 25-hydroxyvitamin D concentrations. Similar to previous studies in adults, brain lesions detected on MRI and CSF oligoclonal bands in children are probable precursors to the clinical onset of multiple sclerosis. Children with a normal MRI are very likely to have a monophasic illness. FUNDING Canadian Multiple Sclerosis Scientific Research Foundation.
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Affiliation(s)
- Brenda Banwell
- Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
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Ramagopalan SV, Guimond C, Criscuoli M, Dyment DA, Orton SM, Yee IM, Ebers GC, Sadovnick D. Congenital abnormalities and multiple sclerosis. BMC Neurol 2010; 10:115. [PMID: 21080921 PMCID: PMC3020672 DOI: 10.1186/1471-2377-10-115] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2010] [Accepted: 11/16/2010] [Indexed: 11/19/2022] Open
Abstract
Background There is a strong maternal parent-of-origin effect in determining susceptibility to multiple sclerosis (MS). One hypothesis is that an abnormal intrauterine milieu leading to impaired fetal development could plausibly also result in increased susceptibility to MS. A possible marker for this intrauterine insult is the presence of a non-fatal congenital anomaly. Methods We investigated whether or not congenital anomalies are associated with MS in a population-based cohort. We identified 7063 MS index cases and 2655 spousal controls with congenital anomaly information from the Canadian Collaborative Project on Genetic Susceptibility to MS (CCPGSMS). Results The frequency of congential anomalies were compared between index cases and controls. No significant differences were found. Conclusions Congenital anomalies thus do not appear to be associated with MS. However, we did not have complete data on types and severity of congenital anomalies or on maternal birth history and thus this study should be regarded as preliminary.
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Koch M, Zhao Y, Yee I, Guimond C, Kingwell E, Rieckmann P, Sadovnick D, Tremlett H. Disease onset in familial and sporadic primary progressive multiple sclerosis. Mult Scler 2010; 16:694-700. [PMID: 20378663 DOI: 10.1177/1352458510367661] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The pathophysiology of primary progressive (PP) multiple sclerosis (MS) involves diffuse axonal degeneration which is believed to start early in the disease process, even before the onset of clinical symptoms. Symptomatic onset then occurs when this process reaches a threshold after which the axonal loss can no longer be compensated. A preliminary study showed that patients with familial PPMS had an earlier clinical onset than patients with sporadic disease, suggesting a hereditary component to the disease process of PPMS. In this study, we combined data from two large, population-based, longitudinal MS databases to investigate disease onset in familial and sporadic PPMS. We examined 411 patients with PPMS. There were no differences in gender distribution or onset symptoms between familial and sporadic PPMS. Patients with familial PPMS were significantly younger at disease onset (n = 84, median age: 37.6 years) than patients with sporadic disease (n = 327, median age: 42.7, p = 0.007). This difference was due to a greater proportion of familial cases with a disease onset before the age of 30 and a smaller proportion with disease onset between 40 and 50 years of age (p = 0.002). Gender had no significant effect on the age at disease onset. Further analyses showed that these findings were unlikely to be due to ascertainment bias towards an earlier diagnosis in familial cases. Our findings suggest a hereditary component to the disease process of PPMS. It would be worthwhile to identify patients with familial PPMS for future research on disease modifying genes in MS.
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Affiliation(s)
- M Koch
- Faculty of Medicine, Division of Neurology, University of British Columbia, Vancouver, Canada.
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Magalhaes S, Venkateswaran S, Belabani C, Ouamara N, Sadovnick D, Arnold D, Poupon V, Banwell B, Bar-Or A. Biomarkers in Pediatric Multiple Sclerosis: Predicting Recurrent Disease at the Initial Demyelinating Episode. Clin Immunol 2010. [DOI: 10.1016/j.clim.2010.03.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hanwell HEC, Vieth R, Bar‐Or A, Magalhaes S, Sadovnick D, Arnold D, Banwell B. Serum 25‐hydroxyvitamin D as a determinant of multiple sclerosis outcome following a pediatric demyelinating event. FASEB J 2009. [DOI: 10.1096/fasebj.23.1_supplement.345.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Heather Elaine Courtney Hanwell
- Department of Nutritional SciencesUniversity of TorontoTorontoONCanada
- Pathology and Lab MedicineMount Sinai HospitalTorontoONCanada
| | - Reinhold Vieth
- Department of Nutritional SciencesUniversity of TorontoTorontoONCanada
- Pathology and Lab MedicineMount Sinai HospitalTorontoONCanada
| | - Amit Bar‐Or
- Montreal Neurological InstituteMontrealQCCanada
| | | | - Dessa Sadovnick
- Department of Medical Genetics & Faculty of MedicineUniversity of British ColumbiaVancouverBCCanada
| | | | - Brenda Banwell
- Division of NeurologyHospital for Sick ChildrenTorontoONCanada
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Banwell B, Kennedy J, Sadovnick D, Arnold DL, Magalhaes S, Wambera K, Connolly MB, Yager J, Mah JK, Shah N, Sebire G, Meaney B, Dilenge ME, Lortie A, Whiting S, Doja A, Levin S, MacDonald EA, Meek D, Wood E, Lowry N, Buckley D, Yim C, Awuku M, Guimond C, Cooper P, Grand'Maison F, Baird JB, Bhan V, Bar-Or A. Incidence of acquired demyelination of the CNS in Canadian children. Neurology 2009; 72:232-9. [DOI: 10.1212/01.wnl.0000339482.84392.bd] [Citation(s) in RCA: 232] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Green RC, Cupples LA, Kurz A, Auerbach S, Go R, Sadovnick D, Duara R, Kukull WA, Chui H, Edeki T, Griffith PA, Friedland RP, Bachman D, Farrer L. Depression as a risk factor for Alzheimer disease: the MIRAGE Study. Arch Neurol 2003; 60:753-9. [PMID: 12756140 DOI: 10.1001/archneur.60.5.753] [Citation(s) in RCA: 360] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Depression symptoms may be associated with the development of Alzheimer disease (AD). OBJECTIVES To evaluate the association between depression symptoms and risk of AD, and to explore the temporal aspects of this association. SETTING Academic institutions with specialized memory clinics. DESIGN Cross-sectional, family-based, case-control study with standardized self- and proxy questionnaires to collect information on depression symptoms and other risk factors. PARTICIPANTS A total of 1953 subjects with AD and 2093 of their unaffected relatives enrolled in the Multi-institutional Research in Alzheimer's Genetic Epidemiology Study. MAIN OUTCOME MEASURES Odds ratios (ORs) of AD were estimated with and without depression symptoms, adjusted for age, sex, education, history of head trauma, and apolipoprotein E status. RESULTS There was a significant association between depression symptoms and AD (adjusted OR, 2.13; 95% confidence interval [CI], 1.71-2.67). In families where depression symptoms first occurred within 1 year before the onset of AD, the association was higher (OR, 4.57; 95% CI, 2.87-7.31), while in the families where the depression symptoms first occurred more than 1 year before the onset of AD, the association was lower (OR, 1.38; 95% CI, 1.03-1.85). In families where depression symptoms first occurred more than 25 years before the onset of AD, there was still a modest association (OR, 1.71; 95% CI, 1.03-2.82). CONCLUSIONS Depression symptoms before the onset of AD are associated with the development of AD, even in families where first depression symptoms occurred more than 25 years before the onset of AD. These data suggest that depression symptoms are a risk factor for later development of AD.
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Affiliation(s)
- Robert C Green
- Department of Neurology, Genetics Program, Boston University School of Medicine, MA 02118, USA.
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Abstract
OBJECTIVE To evaluate the clinical course of MS in individuals with onset of MS before age 16. METHODS Patients with onset of MS before age 16 (n = 116) with complete clinical information on the clinical course from the MS Clinic at The University of British Columbia (UBC) Site Hospital computerized database (MS-COSTAR) were included in this study. The data were compared to those from the Canadian natural history study for MS clinic attendees, regardless of age at onset. RESULTS The mean duration of observation was 19.76 +/- 0.90 years; the mean age at MS onset was 12.73 +/- 0.25 years. Only three cases (2.6%) had a primary progressive (PP) MS course. To date, 60 (53.1%) of 113 subjects have developed secondary progressive (SP) MS. The 50% probability for SPMS was reached 23 years after onset. For patients with relapsing remitting (RR) or SPMS the mean disease duration from onset to the time of confirmed Expanded Disability Status Scale (EDSS) 3.0 was 16.03 +/- 1.17 years (at mean age 28.47 +/- 1.14); mean duration from onset to the time of EDSS 6.0 was 19.39 +/- 1.43 years (at mean age 32.32 +/- 1.44). Annual relapse rate was 0.54 +/- 0.05 per year. The correlation between the number of relapses during the first year of disease and the course of the disease was also significant. CONCLUSIONS The prevalence of early onset MS (3.6%) in our study confirms the previous findings on early onset MS. A RR course was seen in the majority of cases of early onset MS. A high frequency of relapses, early age at permanent disability, and the presence of malignant cases raise the question of possible early use of disease-modifying therapy in patients with early onset MS.
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Affiliation(s)
- A Boiko
- Division of Neurology and Neurosurgery, Russian State Medical University, Moscow, Russia
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Yee IM, Feldman H, Sadovnick D. The effect of apolipoprotein E genotypes in Alzheimer's disease: Data from the Canadian study of health and aging. Neurobiol Aging 2000. [DOI: 10.1016/s0197-4580(00)82840-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Karlinsky H, Geiger O, MacDougall A, Bloch M, Sadovnick D, Burgess M. A pilot experience in genetic counseling for Alzheimer's disease. Findings relevant to the potential use of APOE genotyping in cognitively impaired individuals. Ann N Y Acad Sci 1996; 802:120-7. [PMID: 8993491 DOI: 10.1111/j.1749-6632.1996.tb32605.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- H Karlinsky
- Vancouver Collaborative Study of Genetic Testing for Alzheimer's Disease Riverview Hospital, Port Coquitlam, B.C., Canada
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Duquette P, Murray TJ, Pleines J, Ebers GC, Sadovnick D, Weldon P, Warren S, Paty DW, Upton A, Hader W. Multiple sclerosis in childhood: clinical profile in 125 patients. J Pediatr 1987; 111:359-63. [PMID: 3625402 DOI: 10.1016/s0022-3476(87)80454-7] [Citation(s) in RCA: 235] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Multiple sclerosis (MS) has its usual onset in early adult life (average age of 30 years), but age at clinical onset varies considerably. The implications of the age of onset on the clinical presentation and course of MS are unclear. This population-based retrospective study presents data from a group of 125 patients with onset of MS before age 16 years and can thus be considered as representative of MS occurring in childhood. It demonstrates that childhood MS is more frequent in girls, that it very often has a relapsing-remitting course, that initial bouts usually involve afferent structures of the central nervous system, that recovery from these is often complete, and that the pace of the disease is slow.
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