Emergency visits climb long before symptom onset in pediatric MS
Children who later develop POMS up to 5 times more likely to seek care
Children and adolescents who go on to develop multiple sclerosis (MS) begin visiting the emergency department more often than their peers as early as a dozen years before their first MS symptoms appear, a new study from Canada suggests.
In fact, over an 18-year period, children later diagnosed with pediatric-onset MS (POMS) who also experienced nervous system conditions were found to make emergency department trips five times more frequently than their counterparts who did not develop MS.
Looking specifically at the types of health issues driving these early visits, children with POMS had more frequent emergency visits for respiratory conditions starting 12 years before symptom onset, the data showed. Visits for other concerns, including nervous system and mental health disorders, peaked in the year before symptom onset.
“[These] findings suggest that the [emergency department] may be an important resource for patients and families seeking health care early in the MS disease course and may have implications for the future earlier identification of POMS,” the researchers wrote.
The study, “Use of the Emergency Department Before Pediatric-Onset Multiple Sclerosis,” was published in the journal Neurology Open Access.
POMS is a form of MS that affects individuals younger than 18. It most commonly presents as relapsing-remitting MS (RRMS) — a disease type characterized by periods of new or worsening symptoms followed by periods of remission.
More active disease compared with adults seen for children with pediatric MS
Compared with adults, children and adolescents diagnosed with MS tend to experience a more active disease, with more frequent relapses, greater lesion burden, and early loss of brain tissue. That loss of brain tissue can interfere with full brain maturation.
As a result, children with POMS have been shown to begin using healthcare services more frequently than their counterparts without MS several years before symptom onset.
However, it is not yet known whether emergency department visits also increase during this presymptomatic period, potentially reflecting early, undiagnosed manifestations of the disease.
To find out, a team led by researchers from across Canada examined emergency department use in 230 children and adolescents with POMS. The researchers compared their records with those of 621 matched controls without MS. About two-thirds of children overall were girls. The mean age at symptom onset in the POMS group was 14, with a mean age at diagnosis of 15.4 years.
Altogether, the team examined medical records spanning as far back as 18 years before MS symptom onset. The data showed that children with POMS had higher annual rates of emergency visits starting 12 years before symptom onset — rates 68% higher than peers without MS.
Those visits peaked in the year immediately before symptoms appeared, when trips to the emergency department were four times more frequent, according to the study.
Greater frequency of emergency visits started 12 years prior to symptoms
Over the 18-year period, the POMS patients had more emergency visits than controls across seven categories, with nervous system conditions showing the largest difference — with visits five times more frequent in children with the neurodegenerative disease than in controls.
Looking at the number of visits per year, patients had relatively low rates of visits across all categories between 18 and 13 years before disease onset. However, visits for respiratory conditions became significantly higher in patients starting 12 years before symptom onset.
Future research could explore whether these [emergency department] visits involve specific patterns (e.g., frequency, severity, or co-occurring symptoms) that distinguish youth who later develop MS from those who do not. … Identifying such early markers could improve risk stratification and support earlier recognition of POMS.
In the year immediately before symptom onset, visits for nervous system disorders, musculoskeletal issues, sense organ problems, and ill-defined symptoms — such as fatigue, dizziness, or feeling unwell without a clear diagnosis — were more common in the year before symptom onset.
According to the researchers, “while some symptoms may clearly indicate MS and warrant timely recognition for diagnosis, others may be nonspecific but potentially reflective of an early disease phase.”
The team added: “This highlights the need for mechanisms to better identify at-risk individuals and facilitate earlier interventions.”
The scientists pointed out the scarce research done to date involving patients with pediatric MS.
“Future research could explore whether these visits involve specific patterns (e.g., frequency, severity, or co-occurring symptoms) that distinguish youth who later develop MS from those who do not,” the team wrote. “Identifying such early markers could improve risk stratification and support earlier recognition of POMS.”
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