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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
Keywords: Pediatric multiple sclerosis, antibody-mediated disease

Ünsal Yılmaz
University of Health Sciences Turkey, Izmir Faculty of Medicine, Dr. Behçet Uz Children's Education and Research Hospital
Turkey

Kıvılcım Gücüyener
Gazi University Faculty of Medicine
Turkey

Merve Yavuz
University of Health Sciences Turkey, Izmir Faculty of Medicine, Dr. Behçet Uz Children's Education and Research Hospital
Turkey

İbrahim Öncel
Hacettepe University Faculty of Medicine
Turkey

Mehmet Canpolat
Erciyes University Faculty of Medicine
Turkey

Sema Saltık
İstanbul University Cerrahpaşa Faculty of Medicine
Turkey

Olcay Ünver
Marmara University Faculty of Medicine
Turkey

Ayşegül Neşe Çıtak Kurt
Yıldırım Beyazıt University Faculty of Medicine, Ankara City Hospital
Turkey

Ayşe Tosun
Adnan Menderes University Faculty of Medicine
Turkey

Sanem Yılmaz
Ege University Faculty of Medicine
Turkey

Bilge Özgör
Inonu University Faculty of Medicine, Turgut Ozal Research Center
Turkey

İlknur Erol
Başkent University Faculty of Medicine
Turkey

Ülkühan Öztoprak
University of Health Sciences Turkey, Dr. Sami Ulus Research and Training Hospital
Turkey

Duygu Aykol Elitez
Dokuz Eylül University Faculty of Medicine
Turkey

Meltem Çobanoğulları Direk
Mersin University Faculty of Medicine
Turkey

Muhittin Bodur
Uludağ University Faculty of Medicine
Turkey

Serap Teber
Ankara University Faculty of Medicine
Turkey

Banu Anlar
Hacettepe University Faculty of Medicine
Turkey

Turkish Pediatric Multiple Sclerosis Study Group

Turkey

 

 


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