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Redefining The Characteristics of Pediatric Multiple Sclerosis In The Era of Antibody-Associated Demyelinating Syndromes

Background: Anti-MOG-IgG and anti-AQP4-IgG antibody-mediated diseases have been described recently. Some patients previously included in multiple sclerosis (MS) series might actually have an antibody-mediated disease. Aim: To describe characteristics of recent pediatric MS cases according to age groups and over time. Method: Data of pediatric MS patients diagnosed between 2015-2021 were collected from 44 pediatric neurology centers across Turkey. Earlier-onset (<12 years) and later-onset (≥12 years) groups, as well as our current and previously published cohort (onset <2015)1 were compared. Patients with anti-MOG-IgG and anti-AQP4-IgG were excluded. Results: A total of 634 children (456 girls) were enrolled; 14.0% was earlier-onset (Figure). The frequency of onset <12 years, ADEM-like initial presentation, brainstem, cerebellar and seizure symptoms, and spinal lesions on MRI were lower; on the other hand, the frequency of CSF-restricted OCBs and sensorial symptoms, and female/male ratio were higher than reported in our previous cohort (Table 1). The earlier-onset group had lower female/male ratio, more frequent initial diagnosis of ADEM, more frequent brainstem and less frequent sensorial symptoms, longer interval between the first two attacks, less frequent spinal cord involvement on MRI, and lower frequency of CSF-restricted OCBs (Tables 2,3). Earlier-onset group was less likely to respond initial disease-modifying therapies (Table 4). Conclusion: Early onset MS (<12 years) is less common than reported previously, likely due to exclusion of patients with antibody-mediated diseases. Thus, pediatric MS appears to be more homogeneous and more similar to adult-onset MS than previously thought. 1. Yilmaz U et al. Eur J Paediatr Neurol. 2017;21(6):864-872