Onset Of MS Research Articles

Increasing age of multiple sclerosis onset from 1920 to 2022: a population-based study

ObjectiveTo study the age at onset of relapsing–remitting multiple sclerosis (RRMS) during the past century.MethodsThis is a population-based cohort study of persons diagnosed with RRMS in Hordaland, Møre, and Romsdal counties, Western Norway, from 1920 to 2022. Individual patient data were available and assessed from previously conducted prevalence and incidence studies in addition to hospital records up until October 31, 2022. Participants were categorized according to onset period and analyzed for temporal trends in age at onset, time from onset to diagnosis, and distribution of onset over time.ResultsWe identified 3364 persons with confirmed RRMS. The mean age at onset significantly increased (p < 0.001) throughout the study period, despite a decrease in time from symptom onset to diagnosis (p < 0.001). The proportion of persons with MS onset after 50 years of age increased from 2.6% before 1970 to 11.9% after 2010. We also found a trend toward a bimodal distribution of age at onset that peaked at around 30 years and 40–45 years of age in the latest period.ConclusionAge at onset of MS significantly increased throughout the study period. This was mainly due to an increasing number of persons with MS, predominantly female, experiencing onset after 40–45 years of age. This bimodal distribution could indicate different susceptibility periods of MS or changes in exposure to risk factors during the observation period.

Using instrumental variables to correct for bias in real-world cohort studies of the effects of disease-modifying treatment in MS

Background: Estimating the effect of disease-modifying treatment of MS in observational studies is impaired by bias from unmeasured confounders, in particular indication bias. Objective: To show how instrumental variables (IVs) reduce bias. Methods: All patients with relapsing onset of MS 1996–2010, identified by the nationwide Danish Multiple Sclerosis Registry, were followed from onset. Exposure was treatment index throughout the first 12 years from onset, defined as a cumulative function of months without and with medium- or high-efficacy treatment, and outcomes were hazard ratios (HRs) per unit treatment index for sustained Expanded Disability Scale Score (EDSS) 4 and 6 adjusted for age at onset and sex, without and with an IV. We used the onset cohort (1996–2000; 2001–2005; 2006–2010) as an IV because treatment index increased across the cohorts. Results: We included 6014 patients. With conventional Cox regression, HRs for EDSS 4 and 6 were 1.15 [95% CI: 1.13–1.18] and 1.17 [1.13–1.20] per unit treatment index. Only with IVs, we confirmed a beneficial effect of treatment with HRs of 0.86 [0.81–0.91] and 0.82 [0.74–0.90]. Conclusion: The use of IVs eliminates indication bias and confirms that treatment is effective in delaying disability. IVs could, under some circumstances, be an alternative to marginal structural models.

Abstract- Poster

Background:The onset of asymptomatic or symptomatic MS may result in specific psychiatric symptoms, as well as the long-term evolution of psychiatric disorders. Psychiatric illnesses that develop several years before MS diagnosis have been documented in the literature, although the phenomena remains poorly understood.Case description:Mrs. YB, a 32-year-old housewife, visited the LGBRIMH OPD. For the previous five years, she had a recurrent history of worry and mild physical complaints. Sleep disturbances, panic episodes, ruminative worries, muscle tension, physical weakness, and chest discomfort were among her complaints. Her mood had also deteriorated, and she was concerned that she was suffering from an incurable medical condition. There is no past psychiatric history or history of suicidal or homicidal ideation. She sought the advice of several doctors and underwent a thorough neurological evaluation and investigation, which included a physical examination and investigations such as MDCT chest and MRI-LS spine, which indicated no significant abnormalities. Following it, she was diagnosed with an anxiety disorder. Her symptoms significantly improved after she was treated appropriately. She relapsed and noted that the tingling sensation had gotten worse over 2 years. She acquired clinical signs of excessive knee jerk response on her right side of her lower limb. Repeated contrast Enhanced magnetic resonance imaging (MRI) demonstrated T2 Hyperintensities at D2 and minimal post contrast enhancement suggestive of transverse myelitis. The oligoclonal IgG immunoglobulin level in her CSF was 48.70, indicating multiple sclerosis. The patient had methylprednisolone and azathioprine treatment, which significantly relieved her symptoms.Discussion:Even if all previous tests have been done, unusual psychiatric symptoms necessitate a full neurological examination at each subsequent visit. Long-term monitoring will aid in appropriate diagnosis and provide better care for patients, resulting in a higher quality of life. INTRODUCTION: Obsessions: unwanted intrusive thoughts, lead to significant distress.Compulsions: repetitive behaviours or mental acts to neutralize obsessions.Prevalence:2to3% Onset usually in second or third decade of life.15% after the age of 35. Onset after age 50 is rare & more likely to have an organic aetiology (frontal lobes, basal ganglia).[4]Thyroid diseases may be associated with OCD (1.4 times). Studies show dysregulation of the hypothalamic-pituitary-thyroid axis in OCD.Papillary thyroid carcinoma has subthreshold OCD. [6.7.8] CASE REPORT: 54-yr/F with OCD symptoms for 4 months.OBSESSIONS: being contaminated by dirt & something terrible would happen to her family, if she sees lizard or dogs & didn't take bath.COMPULSIONS: counting till 5, bathing >10 times/day (>30 minutes), washing vessels 5 times.Avoids going out of home, taking bath for past 2 months.Sleeplessness, anxiety,worry about her illness, depressive mood.MEDICAL H/O: thyroid surgery 10 years ago. On T.THYROXINE 300mcg,raised TFT 4 months back,Now on T. THYROXINE 50 mcgNo other significant h/o.Y-BOCS:34.MRI BRAINHyperintensities B/L subcortical white matter Small ischemic changes predominant in frontal lobeTFTT3-125ng/dL T4-22.35Ug/dL TSH<0.05MIU/mLOTHERSWNL MANAGEMENT: SSRI +TCA + Psychotherapy +Thyroxine DISCUSSION: secondary OCD: accompany or follow systemic/neurologic illness.functional neuroimaging studies highlighted differences in regional blood flow.Patients with Thyroid abnormalities also develop OCD.So, always rule out organicity in late onset OCD.

Longitudinal analysis of disability outcomes among young people with MS

BackgroundThe age of onset of MS appears to influence the course of disease progression and people with younger age of onset might have a different disability trajectory. ObjectivesTo identify longitudinal patterns of disability progression, as measured by changes in the Multiple Sclerosis Functional Composite (MSFC), of young people in MS drug trials and to estimate the extent to which disability progression differ in two age groups (≤25 years and 26 – 35 years). MethodsData from the Multiple Sclerosis Outcomes Assessment Consortium (MSOAC) was used. Longitudinal patterns on the MSFC were identified using group-based trajectory models (GBTM). For difference between the expected and observed proportions of people with pediatric-onset MS chi-square statistic was used. Linear mixed models were used to estimate the average change in performance over time, age and sex. ResultsGBTM results showed little variability in performance over time. Mixed modeling showed that the younger group performed better for gait speed, dexterity, and cognition. Men performed poorer on dexterity and cognition. Distribution of people with pediatric-onset MS differed from expected on dexterity, cognition, and the EDSS. ConclusionsThe combined use of trajectory models and linear mixed models provided rich information about the variability in function over time.

Do Pregnancies Forestall the Onset of MS?

Do Pregnancies Forestall the Onset of MS?

‘Is RLS a harbinger and consequence of MS?: Striking results of the ‘RELOMS-T’ study’

BackgroundAlthough studies report a high prevalence rate of restless legs syndrome (RLS) among patients with multiple sclerosis (PwMS) ranging from 13.3 to 65.1%, little is known about the causes of this relationship. MethodsTo ascertain the prevalence, features and impact of RLS among PwMS a nation-wide, multicenter, prospective and a cross-sectional survey, designed to reflect all of the PwMS throughout Turkey, was conducted in 13 centers. Exploring the relationship of the two conditions could possibly contribute to the understanding of the causes of the high and wide-ranging prevalence rates and the pathophysiology of both diseases. ResultsOf the 1068 participants 173 (16,2%) found to have RLS [RLS(+)] and 895 (83,8%) did not [RLS(-)]. Among the RLS(+) 173, all but 8 patients (4,6%) were underdiagnosed in terms of RLS. More than half of the patients with RLS had ‘severe’ or ‘very severe’ RLS. The onset of RLS was before or synchronous with the onset of MS in about a half of our patients. ConclusionWe conclude that RLS should be meticulously investigated in PwMS and MS can be a direct cause of RLS at least in part of PwMS. Our data about the timing of the onset of MS and RLS, along with the high prevalence of RLS in PwMS suggest that the pathologic changes in the initial phases of MS can possibly trigger RLS symptoms.

Causes of delayed diagnosis of multiple sclerosis in egypt

Abstract © 2018 Institute of Psychiatry, Ain Shams University Copyright r 2018 Institute of Psychiatry, Ain Shams University. Unauthorized reproduction of this article is prohibited. Background MS is an inflammatory and neurodegenerative disease. Early inflammatory activity might have a profound impact on the risk of developing early disability, and might be a risk factor for early transition into the progressive phase of the illness. However, there are a number of barriers implementing early MS diagnosis and treatment as the patients may delay consulting a physician about their neurological symptoms or may be reluctant to start DMT. Objective The aim of this study is to highlight the causes of delayed diagnosis of multiple sclerosis in Egypt to shorten the time of diagnosis and improve the prognosis for patients with MS. Patients and Methods Retrospective descriptive study .500 Patients coming to multiple sclerosis unit at Ain Shams University hospitals with delayed diagnosis of MS for more than 2 years had been screened. A questionnaire could be applied on 320 patients out of 500. Contacting (direct and via phone calls) the patients for evaluating the causes of delayed diagnosis of MS was done. Results In this study we found number of significant factors adversely affected a timely diagnosis including the age at onset finding that those younger at onset of MS (vs. older) experienced diagnostic delays (P-value = 0.005) and denial of symptoms which was a leading cause for delayed time to first doctor consultation and delayed diagnosis of MS (P-value =0.009). Also there was a correlation between types of MS and delayed diagnosis as we found that PPMS versus RRMS had delayed diagnosis for more than 2 years. Meanwhile, sensory symptoms at onset of the disease were associated with longer diagnostic delay. Although the first specialties the patients visit were ophthalmology and orthopedic services, that the most common Source of referral to a neurologist was suggestion by family and media. Conclusion multiple causes significantly affect time to diagnosis of MS including age at onset of the disease, denial of symptoms sensorial symptoms at the disease onset and referral delay from other specialties.

Risk Factors and Prevalence of Familial Multiple Sclerosis: A Population- Registry Based Study

Familial multiple sclerosis (FMS) study is important to recognize the correlated effects of environment and genes in the etiology of disease. The present study examined important variables related to risk of FMS and its prevalence and incidence. The cross-sectional study was conducted in Tehran, Iran from 1999 to 2018 on 21,580 MS patients registered in the Iranian MS Society (IMSS). The subjects were measured as FMS if they had at least one relative diagnosed with MS in their family.To examine factors associating with FMS recurrence, patients with familial history of disease were more divided to pediatric onset MS (POMS) and adult onset of MS (AOMS). P-values < 0.05 were considered significant. Familial MS observed among 13.04% of patients. The age standardized prevalence of FMS increased from 9.3 to 18.3 per 100,000 during the study period. The FMS recurrence was significantly higher in female than male (P = 0.001). Mean age of MS onset was 28.49 years old and FMS had significantly lower age than sporadic MS (P=0.036). The occurrence of POMS was higher in patients with FMS compared to those without family history (8.1% vs. 6.6%). The majority of FMS cases were in first degree of relatives, with the highest rate among siblings (35.38%). Significantly higher frequency of FMS was among pediatrics than adults (15.8% vs. 13.2%, P=0.007). The strongest association among POMS was found for mother (p=0.002) and paternal grandmother/grandfather (p=0.009). The higher probability of MS occurrences between mother and offspring (7.99%) than between father and offspring (2.34%) was observed. The increasing prevalence of FMS particularly among POMS in Tehran and displayed a parent-child pairs highlighted more examination on the significant role of genetic and environmental mechanisms in FMS pathogenesis.

Progress in progressive MS

Remarkably, progressive MS has stood the test of time and is still with us. This is despite longstanding difficulties with the diagnosis of progressive MS, the onset of progressive MS in patients with initial relapse onset disease, the translation of conceptual progressive MS to the individual patient and importantly a secure understanding of the processes underlying progression. Nevertheless, despite these difficulties there is appreciable progress in all these areas which will be highlighted to illustrate the changes that are under way. Firstly, a diagnosis of primary progressive MS depends on the absence of a recognised relapse. Fortunately, we now have one highly effective anti-inflammatory medication approved for primary progressive MS. This, in certain circumstances, negates the requirement to delay using anti-inflammatory medication until a relapse or the MRI equivalent occurs. Secondly, many cases of secondary progressive MS have identifiable inflammation and anti-inflammatory medication can improve disability as well as protect relatively spared areas of the CNS such as pathways to the upper limbs and cognition. As a consequence of these changes there is evolving evidence that the effects of secondary progressive MS can be curtailed, if not prevented, by the early use of effective anti-inflammatory medication. Thirdly, there is increasing evidence that the use of progressive worsening of the EDSS in progressive MS treatment trials was likely responsible for the confounding negative outcomes. There is now increasing realisation that advancing lower limb long tract signs more realistically represents degeneration consequent upon past cumulative inflammatory injury at least in part. Fourthly, researchers are now dissecting identifiable pathways that activate the innate immune system and searching to repurpose drugs to modify such activation. The imminent availability of disease activity sensitive fluid biomarkers combined with advances in MRI use in enriched specific patient populations presents the possibility of both positive proof of concept trials to understand the pathogenesis of progression and of therapies targeted to identified pathogenesis rather than to disease phenotypes.

Fine particulate matter and incidence of metabolic syndrome in non-CVD patients: A nationwide population-based cohort study.

It has been reported that particulate matter (PM) is associated with cardiovascular diseases (CVD) while metabolic syndrome is also an important risk factor for CVD. However, few studies have investigated the epidemiological association between PM and metabolic syndrome. To investigate the association between one-year exposure to PM with an aerodynamic diameter <2.5 μm (PM2.5) and the risk of metabolic syndrome in Korean adults without CVD. Exposure to PM2.5 was assessed using a Community Multiscale Air Quality (CMAQ) model. Metabolic syndrome was defined by National Cholesterol Education Program Adult Treatment Panel III. Andersen and Gill model with time-varying covariates, considering recurrent events, was used to investigate the association between one-year average PM2.5 and the risk of incident metabolic syndrome in 119,998 adults from the national health screening cohort provided by Korea National Health Insurance from 2009 to 2013. Higher risk of metabolic syndrome, waist-based obesity, hypertension, hypertriglyceridemia, low HDL cholesterol, and hyperglycemia were significantly associated with a 10-μg/m3 increase in PM2.5 [adjusted hazard ratio (HR): 1.070, 1.510, 1.499, 1.468, 1.627 and 1.380, respectively]. In addition, the risk of metabolic syndrome associated with PM2.5 exposure was significant in the consistently obese group (obese at baseline and endpoint). Exposure to one-year average PM2.5 is associated with an increased risk of metabolic syndrome and its components in adults without CVD. These associations are particularly prominent in the consistently obese group (obese at baseline and endpoint). Our findings indicate that PM2.5 affects the onset of MS and its components which may lead to increase the risk of CVD.

Cervical spinal cord atrophy: An early marker of progressive MS onset.

ObjectiveTo assess whether cervical spinal cord atrophy heralds the onset of progressive MS.MethodsWe studied 34 individuals with radiologically isolated syndrome (RIS) and 31 patients with relapsing-remitting MS (RRMS) age matched to 25 patients within a year of onset of secondary progressive MS (SPMS). Two raters independently measured (twice per rater) the cervical spinal cord average segmental area (CASA) (mm2) of axial T2-weighted images between C2 and C7 landmarks. The midsagittal T2-weighted image from the end of C2 to the end of C7 vertebra was used to measure the cervical spine (c-spine) length (mm). Sex, age at cervical MRI, number and location of cervical spinal cord lesions, c-spine length, and diagnoses were analyzed against the outcome measures of CASA and C2 and C7 slice segmental areas.ResultsIntrarater and interrater agreement was excellent (intraclass correlation coefficient >0.97). The CASA area (p = 0.03) and C7 area (p = 0.002) were smaller in SPMS compared with RRMS. The C2 area (p = 0.027), CASA (p = 0.004), and C7 area (p = 0.003) were smaller in SPMS compared with RIS. The C2 area did not differ between SPMS and RRMS (p = 0.09). The C2 area (p = 0.349), CASA (p = 0.136), and C7 area (p = 0.228) did not differ between RIS and MS (SPMS and RRMS combined). In the multivariable model, ≥2 cervical spinal cord lesions were associated with the C2 area (p = 0.008), CASA (p = 0.009), and C7 area independent of disease course (p = 0.017). Progressive disease course was associated with the C7 area independent of the cervical spinal cord lesion number (p = 0.004).ConclusionCervical spinal cord atrophy is evident at the onset of progressive MS and seems partially independent of the number of cervical spinal cord lesions.Classification of evidenceThis study provides Class III evidence that MRI cervical spinal cord atrophy distinguishes patients at the onset of progressive MS from those with RIS and RRMS.

Longitudinal changes in sleep disturbances, mental toughness, and physical activity in patients with multiple sclerosis

BackgroundMultiple sclerosis (MS) is a chronic progressive autoimmune disease. Fatigue, depression and cognitive impairments are the most common symptoms of patients with MS. Whereas there is extant research on fatigue, depression, and cognitive impairment of patients with MS during the clinical course, no research focused on the long term changes of psychological functioning, sleep problems, and physical activity on these patients. The aims of the present study were therefore to examine changes in physical activity, sleep disturbances, and mental toughness over a 1.5-year period of time in people with multiple sclerosis after the onset their MS.MethodsA total of 18 patients with diagnosed MS (mean age: M = 33.61 years) took part in this study. They completed a booklet of questionnaires covering socio-demographic data, mental toughness, sleep disturbances, and physical activity, at the onset of disease and 1.5 years later.ResultsIn total, 1.5 years after the onset of MS, patients had lower levels of vigorous physical activity, but not statistically significant change in moderate physical activity. Patients with sleep disturbances at the onset of disease had statistically significant sleep disturbances also 1.5 years later.ConclusionsCompared to the onset of disease, 1.5 years later, patients with MS reported similar mental toughness traits, sleep disturbances and levels of moderate physical activity. The pattern of results of the present pilot study suggests that the onset of MS is not an obstacle for doing moderate physical activity. Based on the result of this study, sleep disturbances remains stable by time.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Clinical features, diagnosis and therapeutic strategies in pediatric multiple sclerosis

AbstractMultiple sclerosis (MS) is a complex immune‐mediated disease characterized by recurrent demyelinating episodes of the central nervous system, which typically occurs in young adults. It is the most common disabling neurological disease of young people; however, pediatric MS, defined as onset of MS before the age of 18 years, has been increasingly recognized worldwide in the past two decades. Pediatric MS might represent up to 10% of all patients with MS. As in adults, the diagnosis of pediatric MS rests on the demonstration of dissemination of lesions in both space and time, and the exclusion of alternative diagnosis. However, it can be more difficult to distinguish MS accurately from other conditions in children compared with the adult population, because there is considerable overlapping of clinical and magnetic resonance imaging features between pediatric MS and other acquired demyelinating disorders of the central nervous system. In view of therapeutic strategies, although interferon‐beta and glatiramer acetate are the most commonly used disease‐modifying drugs for pediatric MS so far, none of the current available disease‐modifying drugs were tested in pediatric MS by randomized controlled trials, and thus there is limited information regarding the efficacy and safety. The present review article describes the epidemiology, clinical features, consensus definition and treatment strategy of pediatric MS.

Onset of secondary progressive MS after long-term rituximab therapy - a case report.

A patient with relapsing multiple sclerosis (RMS) was treated with a standard immunomodulatory therapy, but due to ongoing disease activity was switched to rituximab. Relapses ceased, but secondary progressive MS (SPMS) eventually appeared, associated with new focal spinal cord white matter lesions. Cerebrospinal fluid (CSF) showed persistent oligoclonal bands (OCB) and clonally related B cells in CSF and peripheral blood. The treatment escalation approach failed to prevent evolution to SPMS, raising the question of whether initiation of B‐cell depleting therapy at the time of RMS diagnosis should be tested to more effectively address the immune pathology leading to SPMS.

Distinct effects of obesity and puberty on risk and age at onset of pediatric MS.

ObjectiveThe aim of this study was to examine the relative contributions of body mass index (BMI) and pubertal measures for risk and age of onset of pediatric MS.MethodsCase–control study of 254 (63% female) MS cases (onset<18 years of age) and 420 (49% female) controls conducted at 14 U.S. Pediatric MS Centers. Sex‐ and age‐stratified BMI percentiles were calculated using CDC growth charts from height and weight measured at enrollment for controls, and within 1 year of onset for MS cases. Sex‐stratified associations between MS risk and age at symptom onset with both BMI and pubertal factors were estimated controlling for race and ethnicity.ResultsOnly 11% of girls and 15% of boys were prepubertal (Tanner stage I) at MS onset. 80% of girls had onset of MS after menarche. BMI percentiles were higher in MS cases versus controls (girls: P < 0.001; boys: P = 0.018). BMI was associated with odds of MS in multivariate models in postpubertal girls (OR = 1.60, 95% confidence interval [CI]: 1.12, 2.27, P = 0.009) and boys (OR = 1.43, 95% CI: 1.08, 1.88, P = 0.011). In girls with MS onset after menarche, higher BMI was associated with younger age at first symptoms (P = 0.031). Younger menarche was associated with stronger effects of BMI through mediation and interaction analysis. In pubertal/postpubertal boys, 89% of whom were obese/overweight, earlier sexual maturity was associated with earlier onset of MS (P < 0.001).InterpretationHigher BMI in early adolescence is a risk factor for MS in girls and boys. Earlier age at sexual maturity contributes to earlier age at MS onset, particularly in association with obesity.

Inverse comorbidity in multiple sclerosis: Findings in a complete nationwide cohort

BackgroundInverse comorbidity is disease occurring at lower rates than expected among persons with a given index disease. The objective was to identify inverse comorbidity in MS. MethodsWe performed a combined case-control and cohort study in a total nationwide cohort of cases with clinical onset of MS 1980–2005. We randomly matched each MS-case with five population controls.Comorbidity data were obtained from multiple, independent nationwide registries. Cases and controls were followed from January 1977 to the index date, and from the index date through December 2012.We controlled for false discovery rate and investigated each of eight pre-specified comorbidity categories: psychiatric, cerebrovascular, cardiovascular, lung, and autoimmune comorbidities, diabetes, cancer, and Parkinson's disease. ResultsA total of 8947 MS-cases and 44,735 controls were eligible for inclusion.We found no inverse associations with MS before the index date. After the index date, we found a decreased occurrence of chronic lung disease (asthma and chronic obstructive pulmonary disease) (HR 0.80 (95% CI 0.75–0.86, p<0.00025)) and overall cancer (HR 0.88 (95% CI 0.81–0.95, p=0.0005)) among MS-cases. ConclusionThis study showed a decreased risk of cancers and pulmonary diseases after onset of MS.Identification of inverse comorbidity and of its underlying mechanisms may provide important new entry points into the understanding of MS.

Estimating epidemiological data of Multiple sclerosis using hospitalized data in Shandong Province, China.

BackgroundMultiple sclerosis (MS) is a rare chronically debilitating disease. There are few reports on the burden of disease of MS and prevalence in China. The authors intended to estimate disease burden and prevalence of MS in Shandong Province using available epidemiologic data.MethodsPrevalence was calculated using DISMOD II software based on incidence extrapolated from hospitalization data, case fatality and remission rate from literature as input indexes. Disability-adjusted life year (DALY) was computed with epidemiologic indexes estimated by DISMOD II program.ResultsThe prevalence of MS was estimated to be 3.7(95 % CI: 1.65–5.8) and 6.7(95 % CI: 2.7–9.56) cases per 100,000 people for males and for females, respectively. The mean age at onset of MS was 36.0(43.0 ± 30.0 years in males and 33.7(43.4 ± 29.7) years in females. Duration of the disease was estimated to be 34.0 (31.6 ± 21.0) years for males and 39.5(34.9 ± 21.8) years for females. The disease burden in disability-adjusted life years was 3316, comprised of 903 (27.2 %) years of life lost (YLL) and 2413 (72.8 %) years lived with disability (YLD).ConclusionsOur study highlighted that population in Shandong Province had a high prevalence of MS and the patients had a heavy disease burden. It also revealed that the results obtained in this paper would be useful to provide a reference for establishing specific healthcare policies for this rare disease in Shandong Province.

Effect of Obesity and Puberty on Risk and Age at Onset of Pediatric MS (S29.003)

Effect of Obesity and Puberty on Risk and Age at Onset of Pediatric MS (S29.003)

Disease onset in familial and sporadic multiple sclerosis in Argentina

The present study was carried out to assess if there is an anticipation of age at onset in younger generations of familial multiple sclerosis (FMS) vs. sporadic MS (SMS) in Argentina. Methods: multicenter study that included patients from 14 MS Centers of Argentina. Patients were considered as FMS if they had in their family at least one relative of first or second degree diagnosed with MS; otherwise, patients were considered to have SMS. We compared the age at onset between familial and sporadic cases as well as the age at onset between relatives from different generations in FMS vs. SMS. Results: 1333 patients were included, 97 of them were FMS (7.3%). A lower age at onset in the younger generations of FMS cases was found compared with older generations of FMS as well as. SMS cases (24.1±3.7 years vs. 30.3±5.7 years, and 32.4±9.4 respectively; p<0.001). No differences were observed between older generations of FMS vs. SMS cases (p=0.12). Conclusion: we observed an anticipation of age at onset of MS in younger generations of patients with FMS vs. older generations of FMS and SMS.

No prognostic value of routine cerebrospinal fluid biomarkers in a population-based cohort of 407 multiple sclerosis patients.

BackgroundWe aimed to determine the association of clinical and routine cerebrospinal fluid biochemical markers (total protein, IgG index and oligoclonal bands) with disability in multiple sclerosis and whether these biomarkers assessed at diagnosis add prognostic value.MethodsWe followed a cohort of patients included in the Multiple Sclerosis Lorraine Register (eastern France) who had a diagnosis of multiple sclerosis for at least 5 years, as well as biological markers values and MRI findings (Barkhof’s criteria). In a Cox regression model, endpoint was time to score of 4 on the Expanded Disability Status Scale (EDSS) (i.e., limited time walking without aid or rest for more than 500 m).ResultsFor 407 patients included, the median time from multiple sclerosis onset to EDSS score 4 was 4.5 years [2.2–7.2]. Cerebrospinal fluid total protein factor < 500 mg/L was associated with EDSS score 4 on bivariate analysis (hazard ratio 0.66, 95% confidence interval 0.46–0.95, p = 0.02). On multivariate analysis, older age at disease onset (≥50 years) and initial primary progressive course of MS but not biological markers predicted worse prognosis.ConclusionRoutine cerebrospinal fluid biological markers at diagnosis were not prognostic factors of multiple sclerosis progression.