TY - JOUR
T1 - Clinical features and viral serologies in children with multiple sclerosis
T2 - a multinational observational study
AU - Banwell, Brenda
AU - Krupp, Lauren
AU - Kennedy, Julia
AU - Tellier, Raymond
AU - Tenembaum, Silvia
AU - Ness, Jayne
AU - Belman, Anita
AU - Boiko, Alexei
AU - Bykova, Olga
AU - Waubant, Emmanuelle
AU - Mah, Jean K.
AU - Stoian, Cristina
AU - Kremenchutzky, Marcelo
AU - Bardini, Maria Rita
AU - Ruggieri, Martino
AU - Rensel, Mary
AU - Hahn, Jin
AU - Weinstock-Guttman, Bianca
AU - Yeh, E. Ann
AU - Farrell, Kevin
AU - Freedman, Mark
AU - Iivanainen, Matti
AU - Sevon, Meri
AU - Bhan, Virender
AU - Dilenge, Marie Emmanuelle
AU - Stephens, Derek
AU - Bar-Or, Amit
PY - 2007/9
Y1 - 2007/9
N2 - Background: The full spectrum of clinical manifestations and outcome, and the potential importance of regional or demographic features or viral triggers in paediatric multiple sclerosis (MS), has yet to be fully characterised. Our aim was to determine some of these characteristics in children with MS. Methods: 137 children with MS and 96 control participants matched by age and geographical region were recruited in a multinational study. They underwent structured clinical-demographic interviews, review of academic performance, physical examination, disability assessment (MS patients only), and standardised assays for IgG antibodies directed against Epstein-Barr virus, cytomegalovirus, parvovirus B19, varicella zoster virus, and herpes simplex virus. Findings: MS was relapsing-remitting at diagnosis in 136 (99%) children. The first MS attack resembled acute disseminated encephalomyelitis (ADEM) in 22 (16%) of the children, most under 10 years old (mean age 7·4 [SD 4·2] years). Children with ADEM-like presentations were significantly younger than were children with polyfocal (11·2 [4·5] years; p<0·0001) or monofocal (12·0 [3·8] years; p=0·0005) presentations. Permanent physical disability (EDSS≥4·0) developed within 5 years in 15 (13%) of the 120 children for whom EDSS score was available. 23 (17%) had impaired academic performance, which was associated with increasing disease duration (p=0·02). Over 108 (86%) of the children with MS, irrespective of geographical residence, were seropositive for remote EBV infection, compared with only 61 (64%) of matched controls (p=0·025, adjusted for multiple comparisons). Children with MS did not differ from controls in seroprevalence of the other childhood viruses studied, nor with respect to month of birth, sibling number, sibling rank, or exposure to young siblings. Interpretation: Paediatric MS is a relapsing-remitting disease, with presenting features that vary by age at onset. MS in children might be associated with exposure to EBV, suggesting a possible role for EBV in MS pathobiology.
AB - Background: The full spectrum of clinical manifestations and outcome, and the potential importance of regional or demographic features or viral triggers in paediatric multiple sclerosis (MS), has yet to be fully characterised. Our aim was to determine some of these characteristics in children with MS. Methods: 137 children with MS and 96 control participants matched by age and geographical region were recruited in a multinational study. They underwent structured clinical-demographic interviews, review of academic performance, physical examination, disability assessment (MS patients only), and standardised assays for IgG antibodies directed against Epstein-Barr virus, cytomegalovirus, parvovirus B19, varicella zoster virus, and herpes simplex virus. Findings: MS was relapsing-remitting at diagnosis in 136 (99%) children. The first MS attack resembled acute disseminated encephalomyelitis (ADEM) in 22 (16%) of the children, most under 10 years old (mean age 7·4 [SD 4·2] years). Children with ADEM-like presentations were significantly younger than were children with polyfocal (11·2 [4·5] years; p<0·0001) or monofocal (12·0 [3·8] years; p=0·0005) presentations. Permanent physical disability (EDSS≥4·0) developed within 5 years in 15 (13%) of the 120 children for whom EDSS score was available. 23 (17%) had impaired academic performance, which was associated with increasing disease duration (p=0·02). Over 108 (86%) of the children with MS, irrespective of geographical residence, were seropositive for remote EBV infection, compared with only 61 (64%) of matched controls (p=0·025, adjusted for multiple comparisons). Children with MS did not differ from controls in seroprevalence of the other childhood viruses studied, nor with respect to month of birth, sibling number, sibling rank, or exposure to young siblings. Interpretation: Paediatric MS is a relapsing-remitting disease, with presenting features that vary by age at onset. MS in children might be associated with exposure to EBV, suggesting a possible role for EBV in MS pathobiology.
UR - https://www.scopus.com/pages/publications/34547754534
U2 - 10.1016/S1474-4422(07)70196-5
DO - 10.1016/S1474-4422(07)70196-5
M3 - Article
C2 - 17689148
AN - SCOPUS:34547754534
SN - 1474-4422
VL - 6
SP - 773
EP - 781
JO - The Lancet Neurology
JF - The Lancet Neurology
IS - 9
ER -