Early onset multiple sclerosis in Jordan: A retrospective analysis

Abstract

A multicenter retrospective analysis of the clinical characteristics of early onset multiple sclerosis (EOMS) in Jordan was conducted using multiple sclerosis (MS) database of three major referral centers. The database was formulated by collecting information from consecutive MS patients fulfilling the McDonald’s criteria for clinically definite or clinically probable MS, attending neurology clinics in the participating hospitals in the period between August 2004 and September 2005. Patients with disease onset at or before the age of 18 years were included and their data were statistically analyzed. EOMS was seen in 30 patients (13.4%) out of 230, in the Jordan MS database. Estimated prevalence of pediatric MS in Jordan was 5.25/100,000. Female to male ratio was 4:1 (24 females: six males). Twenty-eight (93.3%) subjects had a relapsing-remitting course, while two were primary progressive. None of the patients had a secondary progressive pattern. The majority of our patients (77%) were monosymptomatic at onset. Weakness at onset was seen in 23.3% of patients, which was higher than most of previously reported percentages. Optic neuritis and sensory disturbances were equally observed as presenting symptoms (23.3% each). About 13% of our total patient population had a positive family history of MS in a first degree relative. Six patients were treated with interferon before the age of 18, and tolerated the treatment well. A tendency towards less current disability was noted with earlier age of onset, use of interferon, a relapsing-remitting course and a positive family history of MS. We conclude that EOMS in the Jordanian population is clinically similar to adult onset MS, but slightly different from EOMS in other countries, with a largely monosymptomatic presentation, a higher number of patients with weakness at onset, and the absence of a secondary progressive pattern. This emphasizes the importance of genetic and environmental factors in MS onset.