#AAN2022 – For Children With MS, Symptoms May Predict Future Disability

Children with multiple sclerosis (MS) who in their first year after disease onset experience pyramidal symptoms, such as spasticity or weakness, visual problems, or show signs of cerebellum involvement like poorer coordination are more likely to have worse long-term disability, an analysis of registry data indicates.

The analysis also suggests that an older age at childhood onset and more severe disability in that first year associate with greater long-term disability worsening in pediatric MS.

These findings, its researchers said, could help doctors in making timely decisions when treating these children.

Sifat Sharmin, PhD, a biostatistician with the University of Melbourne, presented the findings at the virtual American Academy of Neurology (AAN) 2022 meeting in April. Her talk was titled “Early Predictors of Disability in Paediatric Multiple Sclerosis: Evidence from a Multi-National Registry.”

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About 3% to 10% of MS patients develop the disease during childhood or adolescence. Pediatric MS tends to differ in some ways from adult-onset disease; for example, children tend to have more relapses and disease activity on MRI scans in the first few years after onset.

Disability also tends to progress more slowly in children. But since the disease is starting at an earlier age, it is common for people with pediatric MS to have marked disease-related disabilities by the time they reach their 30s.

A growing body of evidence suggests that early treatment with disease-modifying therapies (DMTs) may slow long-term disability progression in these patients.

“Early recognition of predictors of faster disability worsening in children is crucial for the clinicians to make treatment decisions at the earliest possible time,” Sharmin said. “In this study, we aim to identify predictors of disability as early as [the] first year from symptom onset.”

The study included 672 children with pediatric MS across 30 countries. Their data was included in the international MSBase Registry, a collaboration dedicated to better understanding MS and other neurological diseases.

The use of data from multiple countries is a noted strength of this analysis, Sharmin noted, as it lessens the likelihood that regional variations in available therapies or care practices will influence its results.

Among the children, the median age at symptom onset was 16, and about 70% were female. Around three-quarters were on a DMT, the most common being interferon-beta products.

The researchers first conducted tests looking for associations between a number of factors — such as sex, age at onset, specific symptoms, and relapse patterns — and MS Severity Score (MSSS), a standardized assessment of MS severity taking into account both disease duration and disability. In all their analyses, the researchers made statistical adjustments to account for the effects of DMTs.

Results showed that an older age at MS onset was significantly associated with a greater likelihood of worsening MS as measured by MSSS. Patients with a higher score on the Expanded Disability Status Scale (EDSS) during the first year after onset, indicating more substantial initial disability, also tended to have poorer long-term MSSS outcomes.

Pyramidal symptoms, or those affecting the pyramidal tracts that control voluntary muscle movements, visual problems, and cerebellar symptoms during the first year also were predictive of worse MSSS scores over time.

In another analysis, the researchers looked for factors that were predictive of having a score of 3 or higher on the EDSS, indicating moderate disability. Here, older age at onset, male sex, and pyramidal symptoms in the first year supported a greater likelihood of such substantial disability.

Analyses using both MSSS and EDSS, however, indicated that patients on long-term DMT use were less likely to experience worsening disability.

“Persistent treatment with higher-efficacy disease-modifying therapies was associated with reduced rate of disability,” Sharmin said.

Note: The Multiple Sclerosis News Today team is providing coverage of the American Academy of Neurology (AAN) 2022 Annual Meeting. Go here to see the latest stories from the conference.