Early escalation of treatment reduces cognitive impairment and prevents decline in Childhood MS

 Johnen A and colleagues from University of Münster, Germany in a recently published study in the European Journal of Paediatric Neurology suggests that early initiation of highly effective escalation therapies in pediatric patients with multiple sclerosis (MS) is associated with reduced cognitive impairment (CI) and may prevent cognitive decline in these patients.

They did a cohort study of 19 patients from a single center in Germany with therapy-naive or ß-interferon-treated juvenile MS (mean age, 15.05 years). The study participants completed a comprehensive neuropsychological assessment at the time of initial presentation and again at a mean follow-up period of 2.5 years. Physical disability was also assessed, along with neurological examination and magnetic resonance imaging (MRI).

At baseline, 47% (n=9) of patients were considered impaired in ≥1 cognitive test (z-score <−1.645 compared with age-adjusted normative data). The highest impairment frequency was found in domains for processing speed, as well as attention and executive function. At follow-up a higher impairment frequency was prominent in those patients whose therapy had not been escalated (N = 13, 69% impaired in at least one test), while cognition was preserved or ameliorated in patients whose treatment had been escalated to highly effective drugs (N = 6, 0% impaired) during the observational period.

These group differences at follow-up were not attributable to differences regarding demographics, MRI metrics or cognitive performance at baseline.
Johnen A, Elpers C, Riepl E, Landmeyer NC, Krämer J, Polzer P et al. (2019) Early effective treatment may protect from cognitive decline in paediatric multiple sclerosis. Eur J Paediatr Neurol 23 (6):783-791. DOI: 10.1016/j.ejpn.2019.08.007 PMID: 31540711
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