Early onset multiple sclerosis

Simone, I. L.; Carrara, D.; Tortorella, Carla; Ceccarelli, Andrea; Livrea, Paolo

doi:10.1007/s100720070027

Cited by 31 publications

(13 citation statements)

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“…75 The first acute event is monosymptomatic and commonly followed by complete clinical recovery, at least in the initial stages. 1,21,76 Sixty percent of children relapse during the first year. 8 A shorter interval between the first and second relapse was seen in patients less than 16 years old compared to adults (1.6 Ϯ 1.6 years vs 2.0 Ϯ 1.8 years).…”

Section: Disease Course and Outcomementioning

confidence: 99%

Clinical features of children and adolescents with multiple sclerosis

Ness

Chabas²,

Sadovnick³

et al. 2007

Neurology

108

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There is increasing appreciation that multiple sclerosis (MS) can begin in childhood or adolescence, but pediatric MS continues to be a rare entity, with an estimated 2 to 5% of patients with MS experiencing their first clinical symptoms before age 16. A prompt diagnosis of pediatric MS is important to optimize overall management of both the physical and social impact of the disease. The widespread use of disease-modifying therapies (DMT) for MS in adults, as early as following an initial isolated episode, has led to the use of DMT in children and adolescents with MS. However, it is imperative to distinguish pediatric MS from other childhood CNS inflammatory demyelinating disorders such as acute disseminated encephalomyelitis. Although increasing evidence suggests a slower disease course in children with MS compared to adults, significant disability can still accumulate by early adulthood. Furthermore, associated neurocognitive deficits can impair both academic and psychosocial function at a critical juncture in a young person's life. This article reviews the clinical characteristics, neuroimaging, paraclinical findings, disease course, epidemiology, genetics, and pathophysiology of pediatric MS vis-à-vis adult MS. Further research of pediatric MS may advance our understanding of MS pathophysiology in general, as well as improve the long-term health care outcomes of children and adolescents diagnosed with MS.

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Section: Disease Course and Outcomementioning

confidence: 99%

Clinical features of children and adolescents with multiple sclerosis

Ness

Chabas²,

Sadovnick³

et al. 2007

Neurology

108

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“…About 2–10% of all patients with multiple sclerosis have clinical onset before the age of 18 years. 15–19 In a national multiple sclerosis registry from Wales, 111 (5·4%) of 2068 of patients had multiple sclerosis onset before the age of 18 years, and only 0·3% had onset before the age of 10 years. 20 The incidence of paediatric multiple sclerosis per 100 000 children per year has been estimated to be 0·13 in France, 18 0·18 in Canada, 21 0·66 in the Netherlands, 8 0·3 in Germany, 22 and 0·51 per 100 000 person-years in the USA.…”

Section: Acute Demyelination Of the Cnsmentioning

confidence: 99%

Multiple sclerosis in children: an update on clinical diagnosis, therapeutic strategies, and research

Waldman¹,

Ghezzi²,

Bar‐Or³

et al. 2014

The Lancet Neurology

132

119

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The clinical features, diagnostic challenges, neuroimaging appearance, therapeutic options, and pathobiological research progress in childhood—and adolescent—onset multiple sclerosis have been informed by many new insights in the past 7 years. National programmes in several countries, collaborative research efforts, and an established international paediatric multiple sclerosis study group have contributed to revised clinical diagnostic definitions, identified clinical features of multiple sclerosis that differ by age of onset, and made recommendations regarding the treatment of paediatric multiple sclerosis. The relative risks conveyed by genetic and environmental factors to paediatric multiple sclerosis have been the subject of several large cohort studies. MRI features have been characterised in terms of qualitative descriptions of lesion distribution and applicability of MRI aspects to multiple sclerosis diagnostic criteria, and quantitative studies have assessed total lesion burden and the effect of the disease on global and regional brain volume. Humoral-based and cell-based assays have identified antibodies against myelin, potassium-channel proteins, and T-cell profiles that support an adult-like T-cell repertoire and cellular reactivity against myelin in paediatric patients with multiple sclerosis. Finally, the safety and efficacy of standard first-line therapies in paediatric multiple sclerosis populations are now appreciated in more detail, and consensus views on the future conduct and feasibility of phase 3 trials for new drugs have been proposed.

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“…Evolution of the disease has been shown to be affected by the time to occurrence of the second attack, as well as by the number of attacks within the first year [9,37]. The rationale for early treatment with immunomodulating drugs to delay the second attack and conversion to definite MS is supported by other previous studies [6,46] [4] (Table 3).…”

Section: Intravenous Immunoglobulin In Clinically Isolated Syndrome (mentioning

confidence: 91%

Intravenous immunoglobulins as therapeutic option in the treatment of multiple sclerosis

Dudešek

Zettl

2006

J Neurol

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Treatment of neurological disorders with intravenous immunoglobulin (IVIG) is an increasing feature of practice for an expanding range of indications. This article reviews the current literature regarding the role of IVIG treatment in multiple sclerosis (MS) and summarizes recommendations for the use of IVIG in different courses and clinical subsets of the disease. Principally based on the results of four randomized, double-blind, placebo-controlled trials (RCTs) and a corresponding meta-analysis, the amount of evidence for the efficacy of IVIG treatment is currently most convincing for the relapsing-remitting course of MS (RRMS); nevertheless, it lags clearly behind that for beta interferon due to smaller study sizes, partial deficits in study design and not established optimal dosage. This prompted the basis for a consensus statement in some countries to recommend IVIG as second-line treatment in RRMS, when other licensed therapies (i. e., beta interferon, glatiramer acetate) are individually not tolerated due to side effects or concomitant disease. Recent evidence indicates that IVIG is also effective in clinically isolated syndrome (CIS) and should be considered as a therapeutic option, particularly when licensed immunotherapy can not be offered. During an acute relapse additional IVIG administration to established steroid treatment showed no benefit. Despite promising experimental data on promotion of remyelination, fixed chronic deficits were not reversed or improved by long-term IVIG treatment either. Currently there is no indication for IVIG treatment in the chronic progressive disease stages, since a large and well-designed RCT failed to show any beneficial effect in patients with secondary progressive MS (SPMS) and data derived from primary progressive MS (PPMS) are still pending. However, preliminary results of a so far unpublished RCT including patients with PPMS and SPMS suggest a strong trend towards a beneficial effect in PPMS. So far, IVIG is the only therapy investigated for reducing postpartum relapses, whereas immunomodulatory drugs are contraindicated during pregnancy and lactation period. Data evaluating the peripartal use of IVIG along with the positive results of the trials in RRMS justify postpartal IVIG treatment particularly for mothers, who choose to breastfeed, under consideration of the recommendations specified for the relapsing-remitting disease course. As recently shown IVIG administration right from the early weeks of pregnancy appears to be a promising strategy, but cannot be recommended from the viewpoint of evidence-based medicine.

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Early onset multiple sclerosis

Cited by 31 publications

References 0 publications

Clinical features of children and adolescents with multiple sclerosis

Clinical features of children and adolescents with multiple sclerosis

Multiple sclerosis in children: an update on clinical diagnosis, therapeutic strategies, and research

Intravenous immunoglobulins as therapeutic option in the treatment of multiple sclerosis

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