Pediatric multiple sclerosis

Yeh, E. Ann; Chitnis, Tanuja; Krupp, Lauren; Ness, Jayne; Chabas, Dorothée; Kuntz, Nancy L.; Waubant, Emmanuelle

doi:10.1038/nrneurol.2009.158

Cited by 125 publications

(85 citation statements)

References 84 publications

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“…4 Unlike adult MS, over 95% of pediatric MS patients (under age 18) initially have a relapsing-remitting course. [5][6][7] Pediatric MS appears to convert to secondary progressive phase MS 10 years later than the adult disease, as measured from time of onset. 7 The estimated median time from onset of symptoms to reach a point where ambulation is limited is 28 to 29 years in pediatric MS, compared with 18 years in adult onset patients.…”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7] Pediatric MS appears to convert to secondary progressive phase MS 10 years later than the adult disease, as measured from time of onset. 7 The estimated median time from onset of symptoms to reach a point where ambulation is limited is 28 to 29 years in pediatric MS, compared with 18 years in adult onset patients. 1,8 Thus, despite the fact that it takes pediatric MS patients longer to reach this disability status, on average they reach it at a younger age.…”

Section: Introductionmentioning

confidence: 99%

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Neuropsychological correlates of multiple sclerosis across the lifespan

et al. 2015

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Neurobiology of pediatric and adult MSThe few pathological studies of pediatric MS suggest that it shares many features with the adult disease. As in adult MS, myelin and axonal damage have also been found in normal-appearing intrahemispheric, interhemispheric, and projection white matter tracts. 9 Despite some remyelination after an attack, over time neurological functioning is permanently decreased due to irreversible axonal injury, depletion of oligodendrocytes, and gliosis. 10 Notably, a recent study has suggested that the extent of acute axonal damage in early active demyelinating lesions is increased by 50% in pediatric patients as compared to adults. 11 This finding may provide some explanation for the often observed severe onset in pediatric MS. Neuropsychological correlates of multiple sclerosis across the lifespanJulia Nunan-Saah, Selvi R Paulraj, Emmanuelle Waubant, Lauren B Krupp and Rowena G Gomez Abstract: Multiple sclerosis can adversely affect cognitive functioning whether the disease has an adult or pediatric onset. The research thus far suggests that pediatric MS shares many features with adult MS but is also unique in several respects. One particular characteristic of pediatric MS is that, while physical disability develops more slowly as compared with adult patients, the impact of cognitive deficits in children may be more substantial as they are in a period of life during which they acquire many skills that are needed to transition into independently functioning adults. Our review takes a lifespan approach to MS, comparing and contrasting the neuropsychology (i.e., cognitive, psychological, and psychosocial factors) of these two populations. Understanding how MS manifests across the lifespan has important implications for tailoring assessment and treatment for individuals with MS as they transition from childhood to adulthood, and later life.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Neuropsychological correlates of multiple sclerosis across the lifespan

et al. 2015

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“…This has limited the ability to study early MS disease pathogenesis and has also posed a challenge to understanding whether, and to what extent, initiating disease mechanisms identified in animal models such as experimental autoimmune encephalomyelitis translate into the human disease. In comparison to adult-onset MS, pediatric-onset MS, which accounts for 2% to 5% of all MS cases, 1,2 provides an opportunity to study immunologic mechanisms that may contribute to early disease pathogenesis. Only a portion of all children presenting with initial symptoms of acquired CNS demyelinating syndrome (ADS) will develop further disease activity establishing the diagnosis of MS. [1][2][3] The remaining children with ADS represent a population with monophasic CNS-directed inflammation, who will not develop further disease activity.…”

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confidence: 99%

“…In comparison to adult-onset MS, pediatric-onset MS, which accounts for 2% to 5% of all MS cases, 1,2 provides an opportunity to study immunologic mechanisms that may contribute to early disease pathogenesis. Only a portion of all children presenting with initial symptoms of acquired CNS demyelinating syndrome (ADS) will develop further disease activity establishing the diagnosis of MS. [1][2][3] The remaining children with ADS represent a population with monophasic CNS-directed inflammation, who will not develop further disease activity. Comparing immune responses of children with ADS who are prospectively ascertained as having either MS (ADS-MS) or monophasic disease (ADS-mono) may therefore provide important insights into early MS disease mechanisms.…”

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confidence: 99%

Epitope spreading as an early pathogenic event in pediatric multiple sclerosis

Quintana¹,

Patel²,

Yeste³

et al. 2014

Neurology

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Objectives: For most adults with initial clinical presentation of multiple sclerosis (MS), biological disease was likely initiated many years prior. Pediatric-onset MS provides an opportunity to study early disease processes.Methods: Using antigen microarrays, including CNS-related proteins, lipids, and other autoantigens, we studied early immunologic events involved in clinical onset of pediatric MS. Serum samples were collected at the time of incident acquired CNS demyelinating syndromes (ADS) in children who, in subsequent prospective follow-up, were ascertained to have either pediatric MS (ADS-MS) or a monophasic illness (ADS-mono). Samples were obtained both at the time of ADS presentation and 3 months into follow-up. We used an initial training set of samples to implicate antibody signatures associated with each group, and then a test set. An additional set of follow-up samples (stability set) was used as a form of internal validation.Results: Children with ADS-MS tended to have distinguishable serum antibody patterns both at the time of ADS presentation and 3 months into follow-up. At the time of ADS, serum samples from patients with ADS-MS or ADS-mono reacted against similar numbers of CNS antigens, although CNS antigens implicated in adult MS were more often targeted in children with ADS-MS. The follow-up ADS-MS samples reacted against a broader panel of CNS antigens, while corresponding ADSmono samples exhibited a contraction of the initial antibody response.Conclusions: Our findings in this prospective cohort of pediatric-onset CNS demyelinating diseases point to an active process of epitope spreading during early stages of MS, not seen in monophasic CNS inflammatory conditions. Neurology ® 2014;83:2219-2226 GLOSSARY ADS 5 acquired CNS demyelinating syndrome; AUC 5 area under the curve; IgG 5 immunoglobulin G; LOOCV 5 leave-oneout cross-validation; mono 5 monophasic; MS 5 multiple sclerosis; NPV 5 negative predictive value; PPV 5 positive predictive value.

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“…Clinically the most common MS presentation in children is polyfocal, contrary to what is observed in adults, where presentation is usually monofocal [10]. Curiously, but in accordance to what was observed in an Indian cohort, our younger (under 10 years old) patients had a majority of monofocal presentations [11].…”

Section: Discussionmentioning

confidence: 45%

Magnetic Resonance Imaging in the Acquired Demyelinating Disorders: A Pediatric Cohort Study

Ignêz¹,

Souza²,

Amâncio³

et al. 2018

JPP

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Abstract:Objective: Describing the characteristics of the MRI (magnetic resonance imaging) of patients with ADD (acquired demyelinating disorder) followed in a specialized pediatric clinic. Methods: Descriptive and retrospective study of the MRIs of a pediatric ADD cohort. The included images were acquired in machines with 1.5 or 3T magnets. Low-quality images were excluded. The radiological characteristics of the lesions were described using the 2010 Revised McDonald Diagnostic Criteria regarding localization, contrast enhancement and optic nerve alterations. Results: Twenty-three patients were included (55% female). The mean age of the first clinical event was 7.7 years. Most common diagnosis was Clinically Isolated Syndrome (35%), followed by Multiple Sclerosis (30%), Neuromyelitis Optica (17%) and Acute Disseminated Encephalomyelitis (17%). Mean time elapsed until diagnosis was 1.8 years. Follow-up MRIs of ADEM patients showed complete or partial resolution of lesions; MS lesions were mostly localized in the brain and four patients had contrast enhancement of lesions in their last available MRI. All NMO (neuromyelitis optica) patients had extensive spinal lesions, and two had optic neuritis. All patients with CIS (clinically isolated syndrome) had focal spinal lesions and evolved with radiologic improvement. Conclusions: ADEM and CIS patients' MRIs showed lesion reduction, while MS and NMO patients developed new lesions during follow-up.

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Pediatric multiple sclerosis

Cited by 125 publications

References 84 publications

Neuropsychological correlates of multiple sclerosis across the lifespan

Neuropsychological correlates of multiple sclerosis across the lifespan

Epitope spreading as an early pathogenic event in pediatric multiple sclerosis

Magnetic Resonance Imaging in the Acquired Demyelinating Disorders: A Pediatric Cohort Study

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