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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