Retrospective Study Analyzes Physical, Mental Differences Between Children with MS and ADS

Retrospective comparison between children with multiple sclerosis (MS) and those with related acute demyelinating syndromes (ADS) highlights the implications of fatigue, depression, and quality of life in these patients.

Those are the findings from a study, “Fatigue, depression, and quality of life in children with multiple sclerosis: a comparative study with other demyelinating diseases” published in the journal Developmental Medicine & Child Neurology.

Demyelinating disorders include any condition that results in damaged myelin (the protective coat of neurons), ultimately leading to the formation of scar tissue and malfunctioning nerve signaling. ADS gathers different diseases in children, and can develop into either monophasic (only one occurrence of demyelination) or multiphasic diseases (chronic demyelination).

MS is the most common type of chronic multiphasic demyelination disease, and studies have associated the condition with cognitive dysfunction, mental conditions, and poor quality of life (QoL), apart from neurological symptoms.

However, few studies have compared fatigue and depression levels between children with MS and ADS. This study retrospectively analyzed and compared those parameters between the two groups, and also evaluated self-reported and parent-reported evaluations about QoL.

The comparative study analyzed the physical and mental functions of children followed in the National Referral Centre of rare inflammatory brain and spinal diseases at the University Hospital of Paris-Sud, France. Researchers assessed 26 children with MS (mean age 15.2 years) and 11 children with ADS (mean age 11.7 years), with follow-up times of 33.6 and 20.3 months, respectively.

ADS included disease-like relapsing myelin oligodendrocyte glycoprotein (MOG, four patients), acute demyelinating encephalomyelitis (three patients), and other clinically isolated syndrome diagnoses (four patients).

Researchers evaluated the level of disability, fatigue, depression, and QoL of the patients based on established clinical scales used in MS patient assessment. The Expanded Disability Status Scale (EDSS) — an assessment tool for MS, with higher scores indicating increased disability — was used to measure impairment.

Results showed a slightly higher EDSS score in ADS compared with MS patients at disease onset (0.5 and 0.1, respectively).

Regarding fatigue severity, researchers found that 43% of the children with MS reported severe fatigue compared with 63% in the group of children with ADS. Although the results indicated that fatigue was more common in ADS compared with MS, this difference was not significant.

Similar to the fatigue scores, the team found no significant differences between the disease groups when analyzing global depression scores. However, children with MS expressed more features of depression (eight features) compared with children with other ADS types (five features). Of note, the three additional features reported by MS patients were self-esteem, pessimism, and defiance.

To score QoL, researchers assessed outcomes from the Pediatric Quality of Life Inventory, reported by patients (self-report) or parents. These QoL assessments included only MS patients.

The outcomes showed that parents (53%) reported poor QoL (measurement scores below 75) more frequently than their children (40%). In particular, while few of the children expressed social problems (5%) as poor QoL score, significantly more responses from parents (37%) indicated that the children experienced issues associated with social functioning. Difficulties in school and emotional problems were the most frequently reported issues affecting QoL by both children and parents (50% and 63%, respectively, for both measurements).

“In conclusion, it is important to underline the necessity of evaluating fatigue and depression in pediatric demyelinating diseases systematically, especially in multiple sclerosis where the prevalence of depression and fatigue is high, and it may interfere with the child’s overall functioning, well-being, and QoL,” the researchers wrote.

The team also emphasized that “difficulties in school and emotional functioning were the main concerns for parents and children in the multiple sclerosis group, which need to be taken in account during their care and treatment proposal.”