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Abstract
Background:
Factors determining severity and recovery of early demyelinating events in pediatric multiple sclerosis (MS) patients are unknown.
Objective:
The objective of this study was to characterize the severity and recovery of early demyelinating events in pediatric MS.
Methods:
Multivariate logistic regression was performed to determine predictors of severe (versus mild/moderate) relapses and poor or fair (versus complete) recovery in patients aged 18 years or less with MS or clinically isolated syndrome (CIS).
Results:
Optic nerve involvement (OR 4.30, 95% CI 1.50–12.3, p = 0.007) was associated with a severe initial demyelinating event (IDE), while non-White race (OR 2.55, 95% CI 0.87–7.49, p = 0.088), localization to the cerebral hemispheres (OR 7.94, 95% CI 0.86–73.8, p = 0.068), or encephalopathy (OR 8.70, 95% CI 0.86–88.0, p = 0.067) showed a trend towards increased IDE severity. A similar association with race was found for severe second events. A severe IDE (OR 6.90, 95% CI 2.47–19.3, p < 0.001) was associated with incomplete IDE recovery, with similar trends for second and third events. Incomplete recovery from the first event predicted incomplete second event recovery (OR 3.36, 95% CI 0.98–11.6, p = 0.055).
References
| 1. |
Renoux, C, Vukusic, S, Mikaeloff, Y. Natural history of multiple sclerosis with childhood onset. N Engl J Med 2007; 356: 2603–2613. Google Scholar | Crossref | Medline | ISI |
| 2. |
Banwell, B, Krupp, L, Kennedy, J. Clinical features and viral serologies in children with multiple sclerosis: a multinational observational study. Lancet Neurol 2007; 6: 773–781. Google Scholar | Crossref | Medline | ISI |
| 3. |
Boiko, A, Vorobeychik, G, Paty, D, Devonshire, V, Sadovnick, D. Early onset multiple sclerosis: a longitudinal study. Neurology 2002; 59: 1006–1010. Google Scholar | Crossref | Medline | ISI |
| 4. |
Ghezzi, A, Deplano, V, Faroni, J. Multiple sclerosis in childhood: clinical features of 149 cases. Mult Scler 1997; 3: 43–46. Google Scholar | SAGE Journals | ISI |
| 5. |
Chitnis, T, Glanz, B, Jaffin, S, Healy, B. Demographics of pediatric-onset multiple sclerosis in an MS center population from the Northeastern United States. Mult Scler 2009; 15: 627–631. Google Scholar | SAGE Journals | ISI |
| 6. |
Waubant, E, Chabas, D, Okuda, DT. Difference in disease burden and activity in pediatric patients on brain magnetic resonance imaging at time of multiple sclerosis onset vs adults. Arch Neurol 2009; 66: 967–971. Google Scholar | Crossref | Medline |
| 7. |
Confavreux, C, Vukusic, S, Adeleine, P. Early clinical predictors and progression of irreversible disability in multiple sclerosis: an amnesic process, Brain 2003; 126: 770–782. Google Scholar | Crossref | Medline | ISI |
| 8. |
Fillippi, M, Horsfield, MA, Morrissey, SP. Quantitative brain MRI lesion load predicts the course of clinically isolated syndromes suggestive of multiple sclerosis. Neurology 1994; 44: 635–641. Google Scholar | Crossref | Medline | ISI |
| 9. |
Mowry, EM, Pesic, M, Grimes, B, Deen, S, Bacchetti, P, Waubant, E. Demyelinating events in early multiple sclerosis have inherent severity and recovery. Neurology 2009; 72: 602–608. Google Scholar | Crossref | Medline | ISI |
| 10. |
Krupp, LB, Banwell, B, Tenembaum, S. Consensus definitions proposed for pediatric multiple sclerosis and related disorders. Neurology 2007; 68: S7–S12. Google Scholar | Crossref | Medline | ISI |
| 11. |
Cherkassky, V, Ma, Y. Comparison of model selection for regression. Neural Comput 2003; 15: 1691–1714. Google Scholar | Crossref | Medline | ISI |
| 12. |
McLaughlin, KA, Chitnis, T, Newcombe, J. Age-dependent B cell autoimmunity to a myelin surface antigen in pediatric multiple sclerosis. J Immunol 2009; 183: 4067–4076. Google Scholar | Crossref | Medline | ISI |
| 13. |
Brilot, F, Dale, RC, Selter, RC. Antibodies to native myelin oligodendrocyte glycoprotein in children with inflammatory demyelinating central nervous system disease. Ann Neurol 2009; 66: 833–842. Google Scholar | Crossref | Medline | ISI |
| 14. |
Ishizu, T, Minohara, M, Ichiyama, T. CSF cytokine and chemokine profiles in acute disseminated encephalomyelitis. J Neuroimmunol 2006; 175: 52–58. Google Scholar | Crossref | Medline | ISI |
| 15. |
Sim, FJ, Zhao, C, Penderis, J, Franklin, RJ. The age-related decrease in CNS remyelination efficiency is attributable to an impairment of both oligodendrocyte progenitor recruitment and differentiation. J Neurosci 2002; 22: 2451–2459. Google Scholar | Crossref | Medline | ISI |
| 16. |
Zhao, C, Li, WW, Franklin, RJ. Differences in the early inflammatory responses to toxin-induced demyelination are associated with the age-related decline in CNS remyelination. Neurobiol Aging 2006; 27: 1298–1307. Google Scholar | Crossref | Medline | ISI |
| 17. |
Franklin, RJ, Kotter, MR. The biology of CNS remyelination: the key to therapeutic advances. J Neurol 2008; 255(Suppl. 1): 19–25. Google Scholar | Crossref | Medline | ISI |
| 18. |
Lucchinetti, CF, Gavrilova, RH, Metz, I. Clinical and radiographic spectrum of pathologically confirmed tumefactive multiple sclerosis. Brain 2008; 131: 1759–1775. Google Scholar | Crossref | Medline | ISI |
