Health issues seen in MS children in 5 years before diagnosis: Study
Findings confirm promdromol period of early symptoms may occur in children
In the five years leading up to a multiple sclerosis (MS) diagnosis, children and adolescents often experience obesity and symptoms such as sensory disturbances and vision problems — potential early signs of MS that could help in diagnosing the condition, according to a new study.
Indeed, the study reports that pediatric patients diagnosed with MS were more commonly found to have had such symptoms than were children and teens without the neurodegenerative condition (controls matched for age and other factors) or people with another autoimmune disease.
The existence of a prodromal period, in which certain unspecific conditions and symptoms become more common before an MS diagnosis, has been extensively demonstrated in adults. According to the researchers, this is one of the first studies confirming it may also exist in young patients.
“The findings suggest that children and adolescents with MS have diverse metabolic, ocular, musculoskeletal, gastrointestinal, and cardiovascular symptoms, signs, and diseases within 5 years before their … MS diagnosis,” the researchers wrote.
A better understanding of these early features may help diagnose the disease earlier, allowing for better outcomes in the long term, the team noted.
The study, “Symptoms Prior to Diagnosis of Multiple Sclerosis in Individuals Younger Than 18 Years,” was published in the journal JAMA Open Network.
Researchers analyze insurance data for healthcare codes
An emerging body of research has suggested that people with MS may start to experience unspecific health problems several years before the condition is diagnosed. These early symptoms, which are referred to as the prodromal phase of MS, may include pain and trouble sleeping, mental health issues, and bladder inflammation and urinary tract infections, as well as sexual dysfunction.
However, most research into the prodromal phase of MS has focused on adults, and little data exist on whether there’s a prodromal phase for MS that develops in childhood or adolescence.
To gain insight, a team led by scientists in Germany conducted an analysis of insurance data collected through the country’s healthcare system. A total of 1,091 young people in the database had a confirmed diagnosis of MS, and these patients were matched in terms of age, sex, and region of residence to 10,910 individuals without MS.
The researchers then used statistical tests to look for insurance codes that were significantly more common among the patients with pediatric-onset MS, or POMS, in the five years before disease onset.
“To our knowledge, this is the first study that systematically examined diagnoses made years before an initial MS diagnosis in a pediatric setting,” the team wrote.
In the main analysis, after sex and age adjustments, we found 9 disorders, signs, and symptoms significantly more frequently diagnosed 5 years before a first MS diagnosis than in children and adolescents without MS.
The results showed nine diagnostic codes that were significantly more common among the POMS patients. These included codes for obesity, stomach and intestine inflammation, knee disorders, heartbeat abnormalities, flatulence, atypical skin sensations, dizziness, as well as two different codes related to eyesight issues.
“In the main analysis, after sex and age adjustments, we found 9 disorders, signs, and symptoms significantly more frequently diagnosed 5 years before a first MS diagnosis than in children and adolescents without MS,” the researchers concluded.
Because problems like heartbeat abnormalities and dizziness aren’t generally common in childhood, the researchers said that clinicians should be aware that these may be warning signs to evaluate a patient for MS.
Findings may be indicative of prodromal phase in POMS
In a secondary analysis, the researchers compared early symptoms from the POMS patients against early health issues seen in more than 1,000 young people with juvenile idiopathic arthritis, known as JIA. Like POMS, JIA is an autoimmune disorder affecting children and adolescents.
These results showed that four of the diagnostic codes seen in the original analysis were also more common before POMS onset than before JIA onset. These codes were for the two eyesight-related issues, obesity, and abnormal skin sensations. By contrast, joint and soft-tissue problems were more commonly seen in patients before JIA onset.
Noting that MS commonly causes eyesight problems and abnormal sensations, the researchers suggested that these symptoms might be indicative of a prodromal phase in POMS. The findings also lend support to the idea that obesity is a risk factor for MS in young people.
The scientists stressed, however, that this analysis was based on insurance data, so further work will be needed to verify the results.
“The study used an exploratory approach to identify possible associations, which need to be validated in future studies,” the team wrote.
“The observed associations may be used to generate hypotheses for future studies,” the researchers added, noting that “better characterization of early symptoms and/or risk factors, [co-occurring] disorders, and possible prodromal features of MS may have considerable implications for early recognition and subsequent progression of the disease.”
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