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August 30, 2016; 87 (9 Supplement 2) Article

Pediatric multiple sclerosis

Clinical features and outcome

Amy Waldman, Jayne Ness, Daniela Pohl, Isabella Laura Simone, Banu Anlar, Maria Pia Amato, Angelo Ghezzi
First published August 29, 2016, DOI: https://doi.org/10.1212/WNL.0000000000003028
Amy Waldman
From the Division of Neurology, Department of Pediatrics (A.W.), Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania; Department of Pediatrics (J.N.), University of Alabama at Birmingham and Children's of Alabama; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department of Basic Medical Sciences, Neurosciences and Sense Organs (I.L.S.), University of Bari, Italy; Department of Pediatric Neurology (B.A.), Hacettepe University, Ankara, Turkey; Department NEUROFARBA, Section Neurosciences (M.P.A.), University of Florence; and Divisione di Neurologia 2–Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy.
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Jayne Ness
From the Division of Neurology, Department of Pediatrics (A.W.), Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania; Department of Pediatrics (J.N.), University of Alabama at Birmingham and Children's of Alabama; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department of Basic Medical Sciences, Neurosciences and Sense Organs (I.L.S.), University of Bari, Italy; Department of Pediatric Neurology (B.A.), Hacettepe University, Ankara, Turkey; Department NEUROFARBA, Section Neurosciences (M.P.A.), University of Florence; and Divisione di Neurologia 2–Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy.
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Daniela Pohl
From the Division of Neurology, Department of Pediatrics (A.W.), Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania; Department of Pediatrics (J.N.), University of Alabama at Birmingham and Children's of Alabama; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department of Basic Medical Sciences, Neurosciences and Sense Organs (I.L.S.), University of Bari, Italy; Department of Pediatric Neurology (B.A.), Hacettepe University, Ankara, Turkey; Department NEUROFARBA, Section Neurosciences (M.P.A.), University of Florence; and Divisione di Neurologia 2–Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy.
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Isabella Laura Simone
From the Division of Neurology, Department of Pediatrics (A.W.), Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania; Department of Pediatrics (J.N.), University of Alabama at Birmingham and Children's of Alabama; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department of Basic Medical Sciences, Neurosciences and Sense Organs (I.L.S.), University of Bari, Italy; Department of Pediatric Neurology (B.A.), Hacettepe University, Ankara, Turkey; Department NEUROFARBA, Section Neurosciences (M.P.A.), University of Florence; and Divisione di Neurologia 2–Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy.
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Banu Anlar
From the Division of Neurology, Department of Pediatrics (A.W.), Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania; Department of Pediatrics (J.N.), University of Alabama at Birmingham and Children's of Alabama; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department of Basic Medical Sciences, Neurosciences and Sense Organs (I.L.S.), University of Bari, Italy; Department of Pediatric Neurology (B.A.), Hacettepe University, Ankara, Turkey; Department NEUROFARBA, Section Neurosciences (M.P.A.), University of Florence; and Divisione di Neurologia 2–Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy.
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Maria Pia Amato
From the Division of Neurology, Department of Pediatrics (A.W.), Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania; Department of Pediatrics (J.N.), University of Alabama at Birmingham and Children's of Alabama; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department of Basic Medical Sciences, Neurosciences and Sense Organs (I.L.S.), University of Bari, Italy; Department of Pediatric Neurology (B.A.), Hacettepe University, Ankara, Turkey; Department NEUROFARBA, Section Neurosciences (M.P.A.), University of Florence; and Divisione di Neurologia 2–Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy.
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Angelo Ghezzi
From the Division of Neurology, Department of Pediatrics (A.W.), Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania; Department of Pediatrics (J.N.), University of Alabama at Birmingham and Children's of Alabama; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department of Basic Medical Sciences, Neurosciences and Sense Organs (I.L.S.), University of Bari, Italy; Department of Pediatric Neurology (B.A.), Hacettepe University, Ankara, Turkey; Department NEUROFARBA, Section Neurosciences (M.P.A.), University of Florence; and Divisione di Neurologia 2–Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy.
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Citation
Pediatric multiple sclerosis
Clinical features and outcome
Amy Waldman, Jayne Ness, Daniela Pohl, Isabella Laura Simone, Banu Anlar, Maria Pia Amato, Angelo Ghezzi
Neurology Aug 2016, 87 (9 Supplement 2) S74-S81; DOI: 10.1212/WNL.0000000000003028

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Abstract

Multiple sclerosis (MS) in children manifests with a relapsing-remitting MS (RRMS) disease course. Acute relapses consist of new neurologic deficits persisting greater than 24 hours, in the absence of intercurrent illness, and occur with a higher frequency early in the disease as compared to adult-onset RRMS. Most pediatric patients with MS recover well from these early relapses, and cumulative physical disability is rare in the first 10 years of disease. Brainstem attacks, poor recovery from a single attack, and a higher frequency of attacks portend a greater likelihood of future disability. Although prospective pediatric-onset MS cohorts have been established in recent years, there remains very limited prospective data detailing the longer-term clinical outcome of pediatric-onset MS into adulthood. Whether the advent of MS therapies, and the largely off-label access to such therapies in pediatric MS, has improved prognosis is unknown. MS onset during the key formative academic years, concurrent with active cognitive maturation, is an important determinant of long-term outcome, and is discussed in detail in another article in this supplement. Finally, increasing recognition of pediatric MS worldwide, recent launch of phase III trials for new agents in the pediatric MS population, and the clear imperative to more fully appreciate health-related quality of life in pediatric MS through adulthood highlight the need for standardized, validated, and robust outcome measures.

GLOSSARY

ADS=
acquired demyelinating syndrome;
ARR=
annualized relapse rate;
BAEP=
brainstem auditory evoked potentials;
CIS=
clinically isolated syndrome;
EDMUS=
European Database for MS;
EDSS=
Expanded Disability Status Scale;
FSS=
functional system score;
IPMSSG=
International Pediatric Multiple Sclerosis Study Group;
MEP=
motor evoked potential;
MS=
multiple sclerosis;
MSFC=
Multiple Sclerosis Functional Composite;
OCT=
optical coherence tomography;
ON=
optic neuritis;
PASAT=
paced auditory serial addition task;
PedsQL=
Pediatric Quality of Life Inventory;
RNFL=
retinal nerve fiber layer;
SDMT=
Symbol Digit Modalities Test;
SPMS=
secondary progressive multiple sclerosis;
SSEP=
somatosensory evoked potentials;
VEP=
visual evoked potentials

Footnotes

  • ↵* These authors contributed equally to this work as co-first authors.

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Supplemental data at Neurology.org

  • Received March 13, 2016.
  • Accepted in final form July 1, 2016.
  • © 2016 American Academy of Neurology
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  • Article
    • Abstract
    • GLOSSARY
    • DEMOGRAPHIC FEATURES
    • CLINICAL FEATURES OF THE INITIAL DEMYELINATING EVENT
    • DISEASE COURSE
    • RELAPSE RATE
    • RELAPSE SEVERITY AND RECOVERY
    • OUTCOME
    • PROGNOSTIC FACTORS FOR CLINICAL DISEASE SEVERITY
    • MEASURING CLINICAL DISEASE SEVERITY IN PEDIATRIC MS
    • DISCUSSION
    • AUTHOR CONTRIBUTIONS
    • STUDY FUNDING
    • DISCLOSURE
    • Footnotes
    • REFERENCES
  • Figures & Data
  • Info & Disclosures
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