Re-examining the characteristics of pediatric multiple sclerosis in the era of antibody-associated demyelinating syndromes.

Ünsal Yılmaz,Olcay Güngör,Edibe Pembegül Yıldız,A Semra Hız Kurul,İlknur Erol,Arzu Ekici,Gülcan Akyüz,Sema Saltık,Müge Ayanoğlu,Deniz Yüksel,Meral Karadağ,Habibe Koç,Nurettin Alıcı,Kürşat Bora Çarman,Selcan Öztürk,Şenay Haspolat,Deniz Yılmaz,Ercan Demir,Salih Akbaş,Ceren Günbey,Bilge Özgör,Nargis Asadova,Aslı Kübra Atasever,Hande Gazeteci Tekin,Muzaffer Polat,Seda Kanmaz,Ersin Yüksel,Mehmet Fatih Yetkin,Tuğçe Damla Dilek,Meltem Çobanoğulları Direk,Filiz Mıhçı,Adnan Deniz,Sevim Şahin,Rabia Tütüncü Toker,Hüseyin Tan,Merve Yavuz,Bahadır Konuşkan,Ayşe Nur Türköz,Dilek Yalnızoğlu,Ergin Atasoy,Özgür Duman,Olcay Ünver,Duygu Aykol Elitez,Aycan Ünalp,Gülten Öztürk,Tülay Kamaşak,Miraç Yıldırım,Mehmet Canpolat,Çetin Okuyaz,Ayşegül Neşe Çıtak Kurt,Mehbare Özkan,Dilşad Türkdoğan,Mine Çiğdem Şenoğlu,Serap Teber,Banu Anlar,Leman Tekin Orgun,Gülen Gül Mert,Burçin Gönüllü Polat,Kıvılcım Gücüyener,Selvinaz Edizer,Pakize Karaoğlu,Hakan Gümüş,Ayşe Aksoy,Hüseyin Per,Emine Tekin,Nazlı Balcan Karaca,Serdal Güngör,Sanem Yılmaz,Neslihan Bilgin,Ömer Bektaş,İsmail Solmaz,Defne Alikılıç,Mustafa Kömür,Ayten Güleç,İbrahim Öncel,Esra Sarıgeçili,Şeyda Beşen,Göknur Haliloğlu,Hamit Acer,Elif Yıldırım,Nurşah Yeniay Süt,Fulya Kürekçi,Esra Gürkaş,Mutluay Arslan,Sedef Terzioğlu Öztürk,Bülent Kara,Filiz Keskin,Coşkun Yarar,Cengiz Dilber,Ülkühan Öztoprak,Büşra Daşlı Dursun,Semra Büyükkorkmaz Öztürk,Serdar Sarıtaş,Senem Ayça,İsmail Hakkı Akbeyaz,Gültekin Kutluk,Muhittin Bodur,Faruk İncecik,Hasan Tekgül,Hülya Kayılıoğlu,Pembe Gültutan,Hepsen Mine Serin,Rojan İpek,Erhan Aksoy,Özlem Yayıcı Köken ,Seçil Oktay ,Mehmet Okan ,I Cetin ,Nihal Olgaç Dündar ,Alptekin Tosun ,Pınar Gençpınar ,Uluç Yış ,Türkan Şahin ,Ayşe Aysima Özçelik ,Dilek Çavuşoğlu

doi:10.1016/j.ejpn.2022.08.006

Abstract

The discovery of anti-myelin oligodendrocyte glycoprotein (MOG)-IgG and anti-aquaporin 4 (AQP4)-IgG and the observation on certain patients previously diagnosed with multiple sclerosis (MS) actually have an antibody-mediated disease mandated re-evaluation of pediatric MS series. To describe the characteristics of recent pediatric MS cases by age groups and compare with the cohort established before 2015. Data of pediatric MS patients diagnosed between 2015 and 2021 were collected from 44 pediatric neurology centers across Türkiye. Clinical and paraclinical features were compared between patients with disease onset before 12 years (earlier onset) and ≥12 years (later onset) as well as between our current (2015-2021) and previous (<2015) cohorts. A total of 634 children (456 girls) were enrolled, 89 (14%) were of earlier onset. The earlier-onset group had lower female/male ratio, more frequent initial diagnosis of acute disseminated encephalomyelitis (ADEM), more frequent brainstem symptoms, longer interval between the first two attacks, less frequent spinal cord involvement on magnetic resonance imaging (MRI), and lower prevalence of cerebrospinal fluid (CSF)-restricted oligoclonal bands (OCBs). The earlier-onset group was less likely to respond to initial disease-modifying treatments. Compared to our previous cohort, the current series had fewer patients with onset <12 years, initial presentation with ADEM-like features, brainstem or cerebellar symptoms, seizures, and spinal lesions on MRI. The female/male ratio, the frequency of sensorial symptoms, and CSF-restricted OCBs were higher than reported in our previous cohort. Pediatric MS starting before 12 years was less common than reported previously, likely due to exclusion of patients with antibody-mediated diseases. The results underline the importance of antibody testing and indicate pediatric MS may be a more homogeneous disorder and more similar to adult-onset MS than previously thought.

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