Multiple sclerosis in childhood: Clinical profile in 125 patients
Multiple sclerosis (MS) has its usual onset in early adult life (average age of 30 years), but age at clinical onset varies considerably. The implications of the age of onset on the clinical presentation and course of MS are unclear. This population-based retrospective study presents data from a group of 125 patients with onset of MS before age 16 years and can thus be considered as representative of MS occurring in childhood. It demonstrates that childhood MS is more frequent in girls, that it very often has a relapsing-remitting course, that initial bouts usually involve afferent structures of the central nervous system, that recovery from these is often complete, and that the pace of the disease is slow.
Available from: Shyuan T Ngo
- "This is surprising, given the impact of puberty on gender bias in autoimmune diseases. For example, while pre-pubertal onset of MS is rare, with only 3–5% of cases reported in individuals under 18 years of age (Chitnis et al., 2009; Duquette et al., 1987; Ghezzi et al., 1997), gender bias within these cases of MS is absent (reviewed in (Chitnis, 2013)). Following the onset of puberty, however , incidence changes rapidly and pubertal girls are found to be at greater risk of developing MS than pre-pubertal girls (Ramagopalan et al., 2010). "
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ABSTRACT: Autoimmune diseases are a range of diseases in which the immune response to self-antigens results in damage or dysfunction of tissues. Autoimmune diseases can be systemic or can affect specific organs or body systems. For most autoimmune diseases there is a clear sex difference in prevalence, whereby females are generally more frequently affected than males. In this review, we consider gender differences in systemic and organ-specific autoimmune diseases, and we summarize human data that outlines the prevalence of common autoimmune diseases specific to adult males and females in countries commonly surveyed. We discuss possible mechanisms for sex specific differences including gender differences in immune response and organ vulnerability, reproductive capacity including pregnancy, sex hormones, genetic predisposition, parental inheritance, and epigenetics. Evidence demonstrates that gender has a significant influence on the development of autoimmune disease. Thus, considerations of gender should be at the forefront of all studies that attempt to define mechanisms that underpin autoimmune disease.
Available from: Emmanuelle Waubant
- "Multiple sclerosis (MS) is an increasingly recognized disorder in children and adolescents. The onset of MS prior to the age of 18 occurs in 3-5% of the total MS population [1-3]. Children and adolescents with MS have higher relapse rates than adults with the disease , suggesting inflammation as a prominent feature. "
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ABSTRACT: Pediatric multiple sclerosis (MS) is a rare disorder with significant consequences. Quantitative MRI measurements may provide significant insights, however multicenter collaborative studies are needed given the small numbers of subjects. The goal of this study is to demonstrate feasibility and evaluate lesion volume (LV) characteristics in a multicenter cohort of children with MS.
A common MRI-scanning guideline was implemented at six member sites of the U.S. Network of Pediatric MS Centers of Excellence. We included in this study the first ten scans performed at each site on patients meeting the following inclusion criteria: pediatric RRMS within 3 years of disease onset, examination within 1 month of MRI and no steroids 1 month prior to MRI. We quantified T2 number, T2-LV and individual lesion size in a total of 53 MRIs passing quality control procedures and assessed gadolinium-enhancing lesion number and LV in 55 scans. We studied MRI measures according to demographic features including age, race, ethnicity and disability scores, controlling for disease duration and treatment duration using negative binomial regression and linear regression.
The mean number of T2 lesions was 24.30 +/- 19.68 (range:1--113) and mean gadolinium-enhancing lesion count was 1.85 +/- 5.84, (range:0--32). Individual lesion size ranged from 14.31 to 55750.60 mm3. Non-white subjects had higher T2--LV (unadjusted pT2-LV = 0.028; adjusted pT2-LV = 0.044), and maximal individual T2-LV (unadjusted pMax = 0.007; adjusted pMax = 0.011) than white patients. We also found a trend toward larger mean lesion size in males than females (p = 0.07).
Assessment of MRI lesion LV characteristics is feasible in a multicenter cohort of children with MS.
Available from: Joaquin Pena
- "MS mainly affects individuals between the ages of 20 and 40 years, with a peak incidence at the age of 30 years. Population studies and case-control series show that between 1.7 and 5.6% of the MS population is younger than 18 years of age     and that onset before 10 years of age occurs in less than 1% of all multiple sclerosis cases  . The global incidence of pediatric MS is unknown, and the few epidemiological studies exhibit variable results. "
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ABSTRACT: Multiple sclerosis (MS), a chronic inflammatory autoimmune disease of the central nervous system (CNS) commonly diagnosed in adults, is being recognized increasingly in children. An estimated 1.7%-5.6% of all patients with MS have clinical symptoms before reaching the age of 18 years. In comparison with adults, the diagnosis of MS in children can be more difficult, being dismissed or misdiagnosed as other clinical disorders. Although adults and children share basic aspects of the disorder, children have distinctive clinical features, neuroimaging, laboratory, and courses of the disease. The 2010 McDonald criteria have simplified the requirements for establishing the diagnosis of MS and have been proposed to be applicable for the diagnosis of pediatric MS, mainly in children 12 years and older. This paper describes the distinctive features of common pediatric demyelinating disorders, including MS, and summarizes the most recent advances based on the available literature.
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