Differences Between Early-Onset and Late-Onset Pediatric Ms – A Retrospective Study

Background: Early onset pediatric Multiple Sclerosis (EOPMS) is a very rare disease but offers a promising opportunity to understand the etiology and development of MS and the influence of puberty and sex hormones on the disease. The study was undertaken to investigate differences between prepubertal and (post)pubertal children with MS regarding various clinical, laboratory and imaging features.

Methods: Children from different European pediatric hospitals with a MS diagnosis according to 2017 McDonald criteria before the age of 18 years and a full data set (e.g relapse rate, MRI scans, EDSS scores) were included. Children were assigned to 2 different groups according to age: 0-10 years as prepubertal (n=53), and 11-17 years as postpubertal (n=221).

Results: In EOPMS, both sexes were equally affected, while in postpubertal children the female sex dominated (p<0.001). Furthermore, prepubertal children have more relapses in the first 2 years (p=0,007). Postpubertal children had more spinal lesions (p=0,004), whilst prepubertal children had a higher amount of infratentorial lesions (p=0.029). OCB can be found equally in the CSF in all age groups. Polysymptomatic onset, spinal lesions at diagnosis and presence of psychological symptoms were examined as prognostic factors for reaching EDSS scores of 1 in EOPMS results.

Conclusion: Our findings suggest that both groups share important similarities such as the presence of OCBs but also important differences such as an increased relapse rate and different MRI features.