Clinical features, disease course and prognosis in patients with paediatric And young adult onset multiple sclerosis.

Paolo Ragonese, Maria Antonietta Mazzola, Marianna Lo Re, Vincenzina Lo Re, Sabrina Realmuto, Giulia Vazzoler, Simona Alessi, Marcella Cammilleri, Giuseppe Salemi, Giovanni Savettieri.

Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC) - University of Palermo, Italy.

ObjectiveObjective

ResultsResults

ConclusionsConclusions

DisclosureDisclosure

MethodsMethods

Maria Antonietta Mazzola, received travel expenses from Biogen idec, Merck serono, Novartis and Sanophy. Paolo Ragonese, received travel expenses or honoraria for consultancy from Merck Serono, Biogen idec, Novartis and Sanophy. Marianna Lo Re, received travel expenses from Biogen idec, and Sanophy. Vincenzina Lo Re, received travel expenses from Biogen idec, and Sanophy. Sabrina Realmuto, received travel expenses from Biogen idec, and Sanophy. Giulia Vazzoler, received travel expenses from Biogen idec, and Sanophy . Simona Alessi, received travel expenses from Biogen idec, and Sanophy. Marcella Cammilleri, has nothing to dislcose. Giuseppe Salemi, received travel expenses or honoraria for consultancy from Merck Serono, Biogen idec, Novartis and Sanophy. Giovanni Savettieri, received travel expenses or honoraria for consultancy from Merck Serono, Biogen idec, Novartis and Sanophy.

BackgroundBackground

Multiple sclerosis (MS) incidence is higher among young adults and people of middle age, while it is uncommon in adolescent and pre-pubescent children Recognition and attention on MS cases with early- onset increased throughout the past decades. This was partly attributable also to new MRI criteria to diagnose MS in childhood, and to increasing awareness in diagnosing the condition, and to the effort to take care of MS much earlier. Epidemiological studies identified that approximately 2% to 5% of patient present first symptoms before the age of 16. Although inflammatory demyelinating diseases of the central nervous system (CNS) occur more often in childhood as monophasic conditions, like acute disseminated encephalomyelitis (ADEM), SSransverse myelitis or optic neuritis, recurrence may anyway happen, supporting a possible diagnosis of MS. Previous studies investigating clinical features and prognostic factors of early onset MS still present methodological differences like for instance, the definition of paediatric or early onset MS, determining lack of concordance.

- To analyse characteristics of MS patients with early onset of

symptoms.

- To compare these clinical features with patients who had MS onset at

later ages;

- To investigate possible early predicotrs of disability progression in

patient with earlier onset compared to those with a young adult onset.

We included MS patients, diagnosed according to validated criteria, attending our

Neurological Department, who had symptoms onset before age 25. They were

classified in three groups according to age at onset; group A: </= 16 years old; group

B: between 17 and 20 years old; and group C: between 21 and 25 years old. The

following characteristics of the three groups were compared: sex ratio, mono - vs.

poly -symptomatic onset, paraclinical criteria like proportion of patients with positive

oligoclonal bands (OCB), frequency of relapses, EDSS score at follow-up.

ReferecesRefereces

1. Simone IL et al. Course and prognosis in early-onset MS. Comparison with adult onset forms. Neurology 2002.

2. Ness JM et al. Clinical features of children and adolescents with multiple sclerosis. Neurology 2007.3. Ferreira ML et al. Pediatric multiple sclerosis. Arq Neuropsiquiatr 2008.4. Mikaeloff Y et al. Prognostic factors for early severity in a childhood multiple sclerosis cohortt.

Pediatrics 2006.

Women Men Total Sex ratio (W:M) p*

Age groups (years)

</= 16 45 29 74 1.55 0.27

17 – 20 112 50 162 2.24 0.65

21 – 25 193 97 290 2.08 0.43

All 350 176 526 1.99 0.45

Table 1 Age and sex groups of the MS population analysed

*X2 analyses between groups (1st vs. 2nd, 2nd vs. 3rd, and 3rd vs. 1st)

p= 0,24

p= 0,6

This study confirms that individuals with a younger onset MS present characteristics different from patients with a typical adult onset of symptoms. We did not observe significant differences between the two younger age groups of patients with respect to clinical onset, rate of OCB positivity, and ARR during the first three years of diseases. Our results show a significant trend among the three age groups in the time to reach an EDSS of 6, and in the time elapsed between the first clinical episode and the following two, in the three groups of patients. The most relevant differences exist between patients who experience an onset preceding the complete body growth compared to those with an adult onset (after 20 years of age). This study confirms that clinical characteristics vary according to age at onset also in MS, suggesting that pathogenic mechanisms of the disease may be influenced by factors modified by age.

0

5

10

15

20

25

30

35

22,9

10,8

17,6

28,4

16,217,9

12,3

24,7

21

17,920,3

7,6

19,7

33,4

11

% o

fp

ati

en

ts

ON= Optic neuritis; ST= supratentorialBst/Cereb= brainstem or cerebellar; Spinal;Multisymptomatic

Mono- and multisymptomatic symptoms of onset

</=16

17-20

21-25

p= 0,02

p= 0,04

p= 0,6

p= 0,2

p= 0,3

0.00

4.48

9.36

14.24

19.12

0.00

Age classes

Mon

ths

Group comparison for time (years) to reachsecondary progressive phase

</= 16

17-20

21-25

p= 0.03

0

5

10

15

20

Men Women Both sexes

Yea

rs

Group comparison for time (years) to reach EDSS 6

</= 16

17-20

21-25

p= 0.003 p= 0.002p= 0.002

Men