Pediatric Multiple Sclerosis in Tunisia: A Retrospective Study over 11 Years

Abstract

Introduction Pediatric multiple sclerosis (pMS) is a rare demyelinating disorder with an onset before the age of 18 years. In this study, we aimed to investigate the characteristics of pMS in Tunisian children. Patients and Methods We conducted a retrospective study over 11 years (2005–2016) including all patients diagnosed with pMS according to the International Pediatric Multiple Sclerosis Study Group (IPMSSG) criteria of 2012 and followed up in a tertiary care research center. Epidemiological, clinical, neuroimaging, laboratory, and therapeutic data were collected and analyzed. Results There were 21 patients. The male-female ratio was 1 : 3. Mean age at onset was 11 years (range: 3–17 years). Three patients had type 1 diabetes. Polyfocal presentation was preponderant (81%) with motor dysfunction in 57% of patients. Paroxysmal dystonia was noticed in 24%. All patients were diagnosed with relapsing-remitting form. Interferon beta was prescribed in 80% with a reduction of annual relapse rate. Conclusion The annual incidence of pMS in Tunisian children aged below 18 years could be estimated as 0.05 per 100,000. Singular features in our cohort were the frequent association with type 1 diabetes and the increased occurrence of dystonia. Greater awareness of pMS may be helpful to improve management strategies of children and their families.

Epidemiology of Pediatric-Onset Multiple Sclerosis: A Systematic Review of the Literature

“…The first case of secondary progressive multiple sclerosis was a girl with disease onset at age 4 years who converted from relapsing-remitting to secondary progressive multiple sclerosis during the pediatric period (age of conversion to secondary progressive multiple sclerosis not reported). 25 This individual had an Expanded Disability Status Scale score 4.5 at disease onset and an Expanded Disability Status Scale score of 3.5 at last follow-up. The second case of secondary progressive multiple sclerosis was a girl aged 17 years 11 months who had been followed for 38 months, age and Expanded Disability Status Scale score at disease onset not reported, age of conversion to secondary progressive multiple sclerosis not reported, and Expanded Disability Status Scale score 2.5 at last follow-up.…”

“…Four studies provided Expanded Disability Status Scale scores for individual cases (n=168). 16,18,24,25 Of these cases, 5/168 (3.0%) children with pediatric-onset multiple sclerosis reached an Expanded Disability Status Scale score of 5.5 or higher during the various follow-up periods. Gudbjornsson et al 34 reported a median Expanded Disability Status Scale score of 0.0 (range 0.0-4.0) for 8 cases.…”

“…Clinical Phenotype and Disease Course in Pediatric MS. progressive multiple sclerosis was a girl with disease onset at age 4 years who converted from relapsing-remitting to secondary progressive multiple sclerosis during the pediatric period (age of conversion to secondary progressive multiple sclerosis not reported) 25. This individual had an Expanded Disability Status Scale score 4.5 at disease onset and an Expanded Disability Status Scale score of 3.5 at last follow-up.…”

Multiple Sclerosis in Childhood: Single Center Experience

“…(21) çalışmasında olguların %65'inde ilk yıl içinde relaps görülmüş, yeterli süre izlenebilen olgulardan hesaplanan ilk 3 yılda her hasta için yıllık relaps oranı 0,95 olarak saptanmıştır. Önceki çalışmalarda pediatrik MS olgularında erişkin MS olgularına göre yıllık relaps oranı anlamlı olarak daha yüksek saptanmıştır (1,1'e karşı 0,4), bunda pediatrik popülasyonun santral sinir sisteminde immün hücrelerin daha fazla bulunması ve immün hücrelerinin daha yoğun immün cevaba sahip olması etken olabilir (23).…”