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Pediatric MS Study Offers New Insight on Disease Course into Adulthood

11/17/2009

Results from new study support recent data suggesting a higher lesion burden in pediatric MS than adult-onset MS. However, the latest study from researchers at the University of Buffalo (UB) also provides additional insight into the course of the disease: Indications are that patients with pediatric-onset MS -- which comprise up to 5 percent of total MS cases -- develop disabilities at a slower pace than patients with adult-onset MS.

"Patients with pediatric-onset MS have three times as many relapses annually than patients with adult-onset disease, which suggests there is greater disease activity in this population," said Bianca Weinstock-Guttman, MD, associate professor of neurology in the UB School of Medicine and Biomedical Sciences and corresponding author. Weinstock-Guttman directs the Pediatric Multiple Sclerosis Center of Excellence located at Women and Children's Hospital, and the William C. Baird MS Center in Buffalo General Hospital.

"But surprisingly, the average time to reach the secondary progressive phase of the disease is longer in patients who develop MS in childhood than in adult onset MS," she continued. "Reaching the next stage of disability is almost 10 years longer in pediatric-onset patients."

The UB study involved four sets of patients:

• 17 children with an average age of 13.7 who were diagnosed with MS 2.7 years earlier

• 33 adults with an average age of 36.5 years who were diagnosed with pediatric MS 20 years earlier

• 81 adults with an average age of 40 who have had MS for an average of 2.6 years

• 300 adults with an average age of 50.5 who've had MS for 20 years

All participants underwent a brain MRI scan, which measured two types of brain tissue damage: T1-lesion volume, which shows "black holes," or hypointense lesions, which are areas of permanent axonal damage; and T2-lesion volume, which shows the total number of lesions (lesion load) and overall disease burden.

Both of these measures indicated that MS is more aggressive in children in the early stages, said Eluen A. Yeh, MD, UB assistant professor of neurology and co-director in the Pediatric Multiple Sclerosis Center. She is first author on the study, which was published online Nov. 5 in Brain.

"Our findings, which are limited to a cross-sectional study design, suggest that children have a somewhat better reserve and functional adaptability than adults, but less support for a better remyelination process," said Weinstock-Guttman. "However, the remyelination process may require a more in-depth prospective analysis"

She also said the data support the need for early diagnosis and therapeutic intervention in pediatric MS patients.

 



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