Longitudinal Neuropsychological Assessment in Pediatric Multiple Sclerosis

Abstract

Although Multiple Sclerosis (MS) occurring in childhood and adolescence has received increasing attention in recent years, the impact of the disease on cognitive function in this subgroup remains poorly understood. It has been posited that children and adolescents with MS may be particularly susceptible to cognitive dysfunction because the pathological processes, including inflammation, blood brain barrier breakdown, and demyelination, occur concurrently with ongoing myelination. Early work has documented that a number of these children present with cognitive deficits. However, there is no available information on the progression of these deficits, or on what clinical factors may predict further decline. The current article reviews what is currently known about pediatric MS and follows a cohort of pediatric MS patients and assesses cognitive function longitudinally. Participants were evaluated with a brief neuropsychological test battery on two separate occasions and correlational analyses assessed the relations between changes in cognition and several clinical variables including level of neurologic impairment, number of relapses prior to baseline assessment, number of interim relapses, age of disease onset, and disease length. The results indicate that a number of these patients experience further cognitive decline over time, or decline from previously normal functioning. Baseline level of neurologic disability was significantly correlated with changes in cognition. The number of interim relapses (i.e., relapses occurring between baseline assessment and re-evaluation) showed a modest relationship to changes in cognitive function, but this did not reach statistical significance.

Disease-Modifying Therapy of Pediatric Multiple Sclerosis

“…Cognitive dysfunction can present early in the course of pediatric multiple sclerosis [22][23][24][25]. One study of 37 children with MS found that 60 % of these children experience cognitive difficulties in 1 major domain, and 35 % have difficulties in 2 domains [23].…”

Pediatric multiple sclerosis

“…11 Most but not all longitudinal studies to date 6,7,[12][13][14][15] report cognitive worsening, with frequencies varying greatly across studies (table 2).…”

International Pediatric MS Study Group Clinical Trials Summit

“…Current research is limited by variable tools used by different research groups, preventing pooling of data across studies, and limited availability of validated assessment tools with satisfactory norms. 6,[21][22][23] Requirements for cognitive batteries to be used in pediatric MS clinical trials are listed in table 3.…”

“…The consequences of MS in a developing brain and early cognitive dysfunction are major concerns that can be evaluated only in children and cannot be extrapolated from studies in adults. 6,7,21,22 Cognitive function should be addressed in any therapeutic trial and requires the development of a core battery of neuropsychological tests applicable to international cross-sectional and longitudinal studies in pediatric MS. Challenges include differences in developmental trajectories and patterns of cognitive dysfunction in relation to patient age.…”