Cognitive functions in pediatric multiple sclerosis: 2-years follow-up

2020 ◽  
Vol 42 (2) ◽  
pp. 159-163 ◽  
Author(s):  
Zeynep Öztürk ◽  
Kıvılcım Gücüyener ◽  
Şebnem Soysal ◽  
Gökçen Düzgün Konuşkan ◽  
Bahadır Konuşkan ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Functions ◽  
Pediatric Multiple Sclerosis

scholarly journals Use of newer disease-modifying therapies in pediatric multiple sclerosis in the US

Neurology ◽  
2018 ◽  
Vol 91 (19) ◽  
pp. e1778-e1787 ◽  
Author(s):  
Kristen M. Krysko ◽  
Jennifer Graves ◽  
Mary Rensel ◽  
Bianca Weinstock-Guttman ◽  
Gregory Aaen ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Side Effect ◽  
Pediatric Patients ◽  
Dimethyl Fumarate ◽  
Short Term ◽  
Pediatric Multiple Sclerosis ◽  
Disease Modifying Therapies ◽  
The Us ◽  
Disease Modifying

ObjectiveTo characterize the use and safety of newer disease-modifying therapies (DMTs) in children with multiple sclerosis (MS) and clinically isolated syndrome (CIS) treated under 18 years of age.MethodsThis is a cohort study including children with MS or CIS followed at 12 outpatient practices participating in the US Network of Pediatric MS Centers. DMT use, including duration, dose, and side effects, was analyzed. Newer DMTs were defined as agents receiving Food and Drug Administration approval or with increased use in adult MS after 2005.ResultsAs of July 2017, 1,019 pediatric patients with MS (n = 748) or CIS (n = 271) were enrolled (65% female, mean onset 13.0 ± 3.9 years, mean follow-up 3.5 ± 3.1 years, median 1.6 visits per year). Of these, 78% (n = 587) with MS and 11% (n = 31) with CIS received DMT before 18 years of age. This consisted of at least one newer DMT in 42%, including dimethyl fumarate (n = 102), natalizumab (n = 101), rituximab (n = 57), fingolimod (n = 37), daclizumab (n = 5), and teriflunomide (n = 3). Among 17%, the initial DMT prescribed was a newer agent (36 dimethyl fumarate, 30 natalizumab, 22 rituximab, 14 fingolimod, 2 teriflunomide). Over the last 10 years, the use of newer agents has increased, particularly in those ≥12 years and to lesser extent in those <12 years. The short-term side effect profiles of newer DMTs did not differ from those reported in adults.ConclusionNewer DMTs are often used in pediatric MS, and have similar short-term safety, tolerability, and side effect profiles as in adults. These findings may help inform pediatric MS management.

Rituximab in patients with pediatric multiple sclerosis and other demyelinating disorders of the CNS: Practical considerations

2020 ◽  
pp. 135245852093279 ◽  
Author(s):  
Angelo Ghezzi ◽  
Brenda Banwell ◽  
Amit Bar-Or ◽  
Tanuja Chitnis ◽  
Russell C Dale ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Pediatric Patients ◽  
Neurological Diseases ◽  
Duration Of Treatment ◽  
Pediatric Multiple Sclerosis ◽  
Immune Mediated ◽  
The Central Nervous System ◽  
Anti Cd20 ◽  
Demyelinating Disorders

Anti-CD20 therapies have established efficacy in the treatment of immune-mediated neurological and non-neurological diseases. Rituximab, one of the first B-cell-directed therapies, is relatively inexpensive compared to newer anti-CD20 molecules, is available in many countries, and has been used off-label in pediatric patients with neuroimmune conditions. The objective of this paper is to describe the experience with rituximab in pediatric multiple sclerosis and other inflammatory immune-mediated disorders of the central nervous system (CNS), and to define a protocol for its use in clinical practice, in particular addressing doses, interval of administration, duration of treatment, and tests to perform at baseline and during follow-up.

scholarly journals Short-term outcomes of pediatric multiple sclerosis patients treated with alemtuzumab at a Canadian University multiple sclerosis clinic

2020 ◽  
Vol 6 (2) ◽  
pp. 205521732092661
Author(s):  
David Jure Hunt ◽  
Anthony Traboulsee
Keyword(s):  
Multiple Sclerosis ◽  
Stable Disease ◽  
Expanded Disability Status Scale ◽  
Short Term ◽  
Pediatric Multiple Sclerosis ◽  
Risks And Benefits ◽  
Disability Status ◽  
Infusion Reactions ◽  
Multiple Sclerosis Patients

There is a lack of literature documenting the use of alemtuzumab in pediatric multiple sclerosis (MS) patients. Here we describe a 16-year-old and a 17-year-old patient receiving alemtuzumab and being followed for 37 months and 20 months, respectively. Both patients experienced a 1.0 decrease in Expanded Disability Status Scale since initial alemtuzumab infusion and had stable disease. No serious infusion reactions, infections, or definite relapses were recorded on follow-up. Alemtuzumab has been relatively well-tolerated and effective; however, larger, longer-term studies are necessary to understand the specific risks and benefits of alemtuzumab in pediatric MS.

scholarly journals Menarche increases relapse risk in pediatric multiple sclerosis

2015 ◽  
Vol 22 (2) ◽  
pp. 193-200 ◽  
Author(s):  
Sabeen Lulu ◽  
Jennifer Graves ◽  
Emmanuelle Waubant
Keyword(s):  
Multiple Sclerosis ◽  
Sex Ratio ◽  
Clinical Features ◽  
Regression Models ◽  
Disease Onset ◽  
Disease Course ◽  
Pediatric Multiple Sclerosis ◽  
Males And Females ◽  
Age Of Menarche

Background: Multiple sclerosis (MS) predominantly affects women with a sex ratio of 3:1 in contrast with a 1:1 sex ratio seen in pre-pubertal onset. Thus, puberty may influence MS risk differentially in males and females. How puberty may be associated with MS clinical features and disease course remains unknown. Objective: The objective of this paper is to determine the association of menarche with disease course in girls with MS. Methods: This is a longitudinal retrospective study from the UCSF Regional Pediatric MS Center database. We categorized patients by time of disease onset: pre-menarche, peri-menarche and post-menarche. Poisson regression models were used for within-subject relapse analyses offset by follow-up time. Results: Seventy-six girls were included (pre-menarche onset = 17; peri-menarche onset = 9; post-menarche onset = 50). Age of menarche was similar in all groups (Kruskal-Wallis p = 0.19). Relapse rate was the same in all three groups during the first two years of follow-up. In girls with follow-up overlapping at least two time periods, within-subject analyses showed increased relapses during the peri-menarche compared to post-menarche period (adjusted IRR = 8.5, 95% CI 2.5–28.7, p = 0.001). Conclusion: Pubertal status may influence MS course at least in female patients. Understanding how puberty influences MS clinical features may offer new insights into important factors regulating disease processes.

scholarly journals Longitudinal evaluation of cognitive functioning in pediatric multiple sclerosis: report from the US Pediatric Multiple Sclerosis Network

2014 ◽  
Vol 20 (11) ◽  
pp. 1502-1510 ◽  
Author(s):  
LE Charvet ◽  
EH O’Donnell ◽  
AL Belman ◽  
T Chitnis ◽  
JM Ness ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Functioning ◽  
Verbal Memory ◽  
Neuropsychological Testing ◽  
Visuomotor Integration ◽  
Pediatric Multiple Sclerosis ◽  
Age Related ◽  
The Us ◽  
Over Time

Background: Approximately one-third of those with pediatric-onset multiple sclerosis (MS) experience cognitive impairment. Less is known concerning their change in cognitive functioning over time. Objective: Changes in cognitive function over time were measured in the largest pediatric cohort to date through the US Network of Pediatric MS Centers. Methods: A total of 67 individuals with pediatric MS ( n=62) or clinically isolated syndrome (CIS, n=5), ranging from 8–17 years of age (mean age±standard deviation (SD)=14.37±2.02) completed initial and follow-up neuropsychological testing after an average of 1.64±0.63 years apart. The nine tests administered measure general intellect, attention and working memory, verbal memory, visuomotor integration, language, and executive functioning. Results: Rate of impairment (having one-third or more scores in the impaired range) was 37% at baseline and 33% at follow-up. Tests commonly impaired were measures of visuomotor integration, speeded processing, and attention. Most tested did not decline over two years. There was no clear pattern of change on any specific measure. Conclusion: Findings suggest that, over short timeframes, stable or even improved performances on measures of cognitive ability can occur. Pediatric MS may instead prevent expected age-related cognitive gains.

Pediatric onset multiple sclerosis: McDonald criteria 2010 and the contribution of spinal cord MRI

2013 ◽  
Vol 19 (10) ◽  
pp. 1330-1335 ◽  
Author(s):  
Hannah-Maria Hummel ◽  
Wolfgang Brück ◽  
Steffi Dreha-Kulaczewski ◽  
Jutta Gärtner ◽  
Jens Wuerfel
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Age At Onset ◽  
Regional Distribution ◽  
Pediatric Multiple Sclerosis ◽  
Mcdonald Criteria ◽  
Spinal Mri ◽  
Magnetic Resonance Imaging Mri ◽  
Pediatric Onset

Background: Diagnostic magnetic resonance imaging (MRI) criteria have not been sufficiently validated in pediatric multiple sclerosis (MS) despite differences in epidemiologic data and clinical disease courses between pediatric and adult MS. Objective: The objective of this paper is to evaluate the diagnostic applicability and validity of the revised McDonald diagnostic criteria 2010 in a large cohort of pediatric-onset MS patients (POMS) and compare them to previously recommended MRI-based classifications. Furthermore, we aimed to investigate the contribution of spinal cord lesions to the revised McDonald criteria 2010. Methods: A cohort of 85 patients with definite MS, age at onset 2.8–18 years, was analyzed in a retrospective multicenter study. Number and regional distribution of T2w and contrast-enhancing T1w lesions at initial and follow-up MRIs were main outcome measures. Results: In 62% of POMS the initial MRI within four weeks after symptom onset was sufficient to diagnose MS according to the revised McDonald criteria 2010. In a subcohort of patients with spinal MRI at first presentation, 10% reached the dissemination in space (DIS) and dissemination in time (DIT) criteria only by the inclusion of contrast-enhancing spinal lesions. Conclusions: The revised McDonald criteria 2010 facilitate the diagnosis of POMS already at first presentation. The addition of a spinal cord MRI was helpful only in selected cases.

Natalizumab in pediatric multiple sclerosis: results of a cohort of 55 cases

2013 ◽  
Vol 19 (8) ◽  
pp. 1106-1112 ◽  
Author(s):  
A Ghezzi ◽  
C Pozzilli ◽  
LME Grimaldi ◽  
L Moiola ◽  
V Brescia-Morra ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Median Number ◽  
Limited Information ◽  
Long Term Effects ◽  
Strong Suppression ◽  
Pediatric Multiple Sclerosis ◽  
Disability Status ◽  
Pre Treatment ◽  
Magnetic Resonance Imaging Mri

Background: Limited information is available on the use of natalizumab (NA) in pediatric multiple sclerosis (ped-MS) patients. Objective: The purpose of this study was to describe the long-term effects of NA in a large cohort of active ped-MS patients. Methods: Patients with definite ped-MS were treated with NA if in the previous year they had experienced at least two relapses or a severe relapse with incomplete recovery while on immunomodulating treatment, or at least two relapses and new magnetic resonance imaging (MRI) lesions regardless of any prior treatment. Results: The study included 55 patients (mean age: 14.4 years, mean number of relapses: 4.4, pre-treatment mean disease duration: 25.5 months). They received a median number of 26 infusions. Three relapses occurred during the follow-up, one female patient continued to deteriorate in cognitive functioning. Mean Expanded Disability Status Scale (EDSS) scores decreased from 2.7 to 1.9 at the last visit ( p<0.001). During the follow-up the majority of patients remained free from MRI activity. Transient and mild clinical adverse events occurred in 20 patients. Mild hematological abnormalities occurred in seven patients. Anti-JCV antibodies were detected in 20/51 tested patients. Conclusions: NA was well tolerated in all patients. A strong suppression of disease activity was observed in the majority of patients during the follow-up.

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