Pediatric-onset multiple sclerosis in Egypt: a multi-center registry of 186 patients

Abstract

IntroductionAlthough the frequency of pediatric-onset multiple sclerosis (POMS) has increased in recent decades, it is still highly uncommon, which creates a need for the involvement of more registries from various clinical centers.ObjectiveTo characterize the demographic, clinical, and paraclinical features of Egyptian patients with POMS.Patients and methodsA retrospective chart review study was undertaken on 237 Egyptian patients with demyelinating events which started before the age of 18 years who attended one of five tertiary referral centers in Cairo, Egypt.ResultsMultiple sclerosis was diagnosed in 186 patients, 47 (25.27%) patients had disease onset before the age of 12 years; “early-onset pediatric multiple sclerosis (EOPMS)”. The mean age of disease onset was (14.13±2.49 years), with a female:male ratio of 1.62:1, none of the enrolled patients had a primary progressive course (PPMS), whereas 10 patients (5.38%) had a secondary progressive form. Approximately two-thirds of the patients had monofocal disease onset, and less than 10% presented with encephalopathy; most of them had EOPMS. Motor weakness was the presenting symptom in half of the patients, whereas cerebellar presentation was detected in 34.95%, mainly in EOPMS. Seizures (not related to encephalopathy) were more frequent in those with EOPMS. Initial brain magnetic resonance images were positive in all patients, with detected atypical lesions in 29.03%, enhanced lesions in 35.48%, black holes in 13.98%, and infratentorial in 34.41%. Cervical cord involvement was found in 68.28%. More than two-thirds of the patients received either immunomodulatory or immunosuppressant (IS) treatment throughout their disease course, and about half of them received their treatment within the first year from symptoms onset, with a more favorable outcome, and patients with highly active disease received natalizumab, fingolimod, or other IS.ConclusionThe results from this registry – the largest for MS in the Arab region to date – are comparable to other registries. Immunomodulatory therapies in POMS are well tolerated and efficacious and they can improve the long-term outcome in children.

Pediatric Multiple Sclerosis—Experience of a Tertiary Care Center

“…This study assessed the records of 21 patients. A discrete female predominance was observed (1.1:1), slightly lower than reported in other studies, 3,4,[18][19][20][21] as well as a mean age at diagnosis in agreement with previous studies (14.8 years). 18,19 Fourteen percent of patients had a family history of other AIDs, but not of MS.…”

“…Although uncommon, it is possible to have positive anti-MOG antibodies in MS. 3 In the present study, the mean time between the first MS manifestation and diagnosis was 2.8 months, similar to one study 18 but lower than reported in others. [19][20][21] Despite the small number of patients included, using the revised 2017 McDonald criteria apparently enabled earlier diagnosis and treatment. Other studies, both before and after 2017, reported a longer mean time until diagnosis than reported in this study.…”

Characteristics of pediatric multiple sclerosis: A tertiary referral center study

“…Relapses of the disease in all patients were treated with high doses of corticosteroids for 3–5 days and 66.7% of them continued with corticosteroid therapy using decreasing doses after day 5. Our results correspond to other studies that reported treatment with high doses of corticosteroids and continuation with corticosteroid therapy at decreasing doses [ 42 , 43 ]. Plasma therapeutic replacement was administered after the ineffectiveness of high doses of corticosteroids, with relatively good outcome.…”

<p>Review Of The Safety, Efficacy And Tolerability Of Fingolimod In The Treatment Of Pediatric Patients With Relapsing-Remitting Forms Of Multiple Sclerosis (RRMS)</p>

“…Furthermore, fingolimod also significantly delayed time to first relapse and 3-month confirmed disability worsening. Effects reported from the clinical trial were echoed in the limited number of previously published observational studies involving fingolimod in POMS 19–21…”

“…Most recently Egyptian registry data of 186 POMS patients were published by Hamdy et al in 2018 21. In this registry, there were a total of 8 patients treated with fingolimod (3 treated within 1 year of symptom onset and 6 treated after more than a year of symptoms since onset).…”