Improved relapse recovery in paediatric compared to adult multiple sclerosis

Author:

Chitnis Tanuja12,Aaen Greg3,Belman Anita4,Benson Leslie5,Gorman Mark5,Goyal Manu S6,Graves Jennifer S7,Harris Yolanda8,Krupp Lauren4,Lotze Timothy9,Mar Soe6,Ness Jayne8,Rensel Mary10ORCID,Schreiner Teri11,Tillema Jan-Mendelt12,Waubant Emmanuelle13,Weinstock-Guttman Bianca14,Roalstad Shelly15,Rose John15,Weiner Howard L216,Casper T Charles15,Rodriguez Moses12,

Affiliation:

1. Partners Paediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston, MA, USA

2. Harvard Medical School, Boston, MA, USA

3. Paediatric Multiple Sclerosis Center, Loma Linda University Children’s Hospital, Loma Linda, CA, USA

4. Paediatric MS Center at NYU Langone Health, New York, NY, USA

5. Paediatric Multiple Sclerosis and Related Disorders Program at Boston Children’s Hospital, MA, USA

6. Washington University, St. Louis, MO, USA

7. Paediatric Multiple Sclerosis Center, University of California San Diego, San Diego, CA, USA

8. UAB Center for Paediatric-Onset Demyelinating Disease, University of Alabama at Birmingham, Birmingham, AL, USA

9. The Blue Bird Circle Clinic for Multiple Sclerosis, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA

10. Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA

11. Rocky Mountain Multiple Sclerosis Center, Children’s Hospital Colorado, University of Colorado at Denver, Aurora, CO, USA

12. Mayo Clinic Paediatric Multiple Sclerosis Center, Mayo Clinic, Rochester, MN, USA

13. Paediatric Multiple Sclerosis Center, University of California San Francisco, San Francisco, CA, USA

14. Jacobs Paediatric Multiple Sclerosis Center, State University of New York at Buffalo, Buffalo, NY, USA

15. Data Coordinating and Analysis Center, University of Utah, Salt Lake City, UT, USA

16. Partners MS Center, Brigham and Women’s Hospital, Boston, MA, USA

Abstract

Abstract Incomplete relapse recovery contributes to disability accrual and earlier onset of secondary progressive multiple sclerosis. We sought to investigate the effect of age on relapse recovery. We identified patients with multiple sclerosis from two longitudinal prospective studies, with an Expanded Disability Status Scale (EDSS) score within 30 days after onset of an attack, and follow-up EDSS 6 months after attack. Adult patients with multiple sclerosis (n = 632) were identified from the Comprehensive Longitudinal Investigations in Multiple Sclerosis at Brigham study (CLIMB), and paediatric patients (n = 132) from the US Network of Paediatric Multiple Sclerosis Centers (NPMSC) registry. Change in EDSS was defined as the difference in EDSS between attack and follow-up. Change in EDSS at follow-up compared to baseline was significantly lower in children compared to adults (P = 0.001), as were several functional system scores. Stratification by decade at onset for change in EDSS versus age found for every 10 years of age, EDSS recovery is reduced by 0.15 points (P < 0.0001). A larger proportion of children versus adults demonstrated improvement in EDSS following an attack (P = 0.006). For every 10 years of age, odds of EDSS not improving increase by 1.33 times (P < 0.0001). Younger age is associated with improved recovery from relapses. Age-related mechanisms may provide novel therapeutic targets for disability accrual in multiple sclerosis.

Funder

National MS Society

Mallinckrodt

The Network of Pediatric MS Centers

Ann Romney Center for Neurological Diseases

Publisher

Oxford University Press (OUP)

Subject

Clinical Neurology

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