Friday, 15 May 2015

Childhood MSers progress slower

Alroughani R, Ahmed S, Al-Hashel J. Paediatric onset multiple sclerosis patients tend to have slower disease progression.
Mult Scler Relat Disord. 2014 3(6):742-3.

BACKGROUND:Data on the difference between pediatric and adult onset multiple sclerosis (MS) in terms of disease course and progression is scare in our region.
OBJECTIVE:To compare the demographic and clinical characteristics between pediatric-onset and adulthood-onset MS.
METHODS:Utilizing the national MS registry, we conducted a cross-sectional study to dichotomize MS patients based on age of disease onset (under 17 years or above). Demographics and clinical characteristics (age, symptoms presentation at onset, disease duration, disease course, relapses, EDSS score, and use of disease modifying therapies) were collected. Simple descriptive statistical tests were used to describe numerical and non-numerical values.
RESULTS:A total of 984 records of MS patients were assessed; of whom 111 (11.3%) had the disease onset before 17 years of age. Paediatric onset MS patients were more likely to be female (female:male ratio 2.5 vs. 1.85; p<0.05), higher brain-stem/cerebellum (36% versus 26%, p<0.03) and multifocal (15.3% versus 8.1%, p<0.01) manifestations at onset. There was no significant difference in the mean EDSS score between the two cohorts (2.51 versus 2.69; p<0.38) or mean number of relapses (3.38 versus 3.05; p<0.14). The time to reach secondary progression MS was longer in the paediatric-onset MS (14.63 versus 11.03 years; p<0.0001). A higher proportion of the paediatric cohort was treated with aggressive therapy (14.4% versus 8.8%; p<0.05) and required earlier escalation therapy (33.3%% versus 27.7%; p<0.04).
CONCLUSIONS:MS patients, who had their disease onset before age 17, tend to be female and have brainstem/cerebellar and multifocal symptoms at disease onset. Despite the comparable relapse rate and disability measures between the two cohorts, patients with paediatric onset had slower disease progression.

Young MSers may convert to secondary progression later after diagnosis than adult MSers. This may be because they also treated more aggressively and have better repair capacities

Young MSers were in the news this week

5 comments:

  1. Treated more aggressively? Could be just done to youthful biology. Perhaps you're just wanting to take credit for Mother Nature.

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  2. Not sure about this my friend and I were early onset..We didn't get SPMS for 25years. No DMTs.

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  3. I'm cynical about any of these studies. How confident are you that MS isn't a life-long disease? Clinically, I was diagnosed at 50, but I had restless leg as a child, anxiety and depression as a teen, odd dizzy spells in my 20s, a summer of being tired in my 30s, a lost sense of temperature in a leg in my 40s, and then double vision when I turned 50. I think the only difference between juvenile and late onset is whether you had an attack that was dramatic enough to get you diagnosed. I wouldn't be surprised if many of is are found to have been born with it.

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    1. Totally agree. I can track my symptoms to 14 years of age, but it wasn't until I was 22 that I became aware that these were symptoms associated with MS, it then took another 14-15 years trekking back and forth to hospital to try to get a diagnosis, and being dismissed - ever so nicely but still dismissed. In the end I paid privately for MRIs, when I developed L'hermitte's sign (dramatic enough for me to a small fortune for neurologists/EPs/MRIs). And yes, finally a diagnosis after an LP. I have the same symptoms some 35 years on, plus many extra but still RRMS. That's quite a long time to have RRMS with a minimal EDSS (only because the EDSS is scewed to motor symptoms), so I'm quite convinced many individuals have MS far sooner than it is picked up on. If I'd ignored my symptoms (l'hermittes lasted only a couple of months)I think it would have been another six years until I received a diagnosis as the next "dramatic event" was then optic neuritis.

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