Early Predictors of 9‐Year Disability in Pediatric Multiple Sclerosis. Issue 5 (27th February 2021)

• Record Type: Journal Article
• Authors: De Meo, Ermelinda; Bonacchi, Raffaello; Moiola, Lucia; Colombo, Bruno; Sangalli, Francesca; Zanetta, Chiara; Amato, Maria Pia; Martinelli, Vittorio; Rocca, Maria Assunta; Filippi, Massimo
• Is Part Of: Annals of neurology. Volume 89:Issue 5(2021)
• Page Start: 1011
• Page End: 1022
• Publication Date: 2021-02-27
• Subjects: Neurology -- Periodicals; Pediatric neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; 616.8
• DOI: 10.1002/ana.26052
• Languages: English
• ISSNs: 0364-5134

Abstract

Abstract : Objective: The purpose of this study was to assess early predictors of 9‐year disability in pediatric patients with multiple sclerosis. Methods: Clinical and magnetic resonance imaging (MRI) assessments of 123 pediatric patients with multiple sclerosis were obtained at disease onset and after 1 and 2 years. A 9‐year clinical follow‐up was also performed. Cox proportional hazard and multivariable regression models were used to assess independent predictors of time to first relapse and 9‐year outcomes. Results: Time to first relapse was predicted by optic nerve lesions (hazard ratio [HR] = 2.10, p = 0.02) and high‐efficacy treatment exposure (HR = 0.31, p = 0.005). Predictors of annualized relapse rate were: at baseline, presence of cerebellar (β = −0.15, p < 0.001), cervical cord lesions (β = 0.16, p = 0.003), and high‐efficacy treatment exposure (β = −0.14, p = 0.01); considering also 1‐year variables, number of relapses (β = 0.14, p = 0.002), and the previous baseline predictors; considering 2‐year variables, time to first relapse (2‐year: β = −0.12, p = 0.01) entered, whereas high‐efficacy treatment exposure exited the model. Predictors of 9‐year disability worsening were: at baseline, presence of optic nerve lesions (odds ratio [OR] = 6.45, p = 0.01); considering 1‐year and 2‐year variables, Expanded Disability Status Scale (EDSS) changes (1‐year: OR = 26.05, p < 0.001; 2‐year: OR = 16.38, p = 0.02), and ≥ 2 new T2‐lesions in 2 years (2‐year: OR = 4.91, p = 0.02). Predictors of higher 9‐year EDSS score were: at baseline, EDSS score (β = 0.58, p < 0.001), presence of brainstem lesions (β = 0.31, p = 0.04), and number of cervical cord lesions (β = 0.22, p = 0.05); considering 1‐year and 2‐year variables, EDSS changes (1‐year: β = 0.79, p < 0.001; 2‐year: β = 0.55, p < 0.001), and ≥ 2 new T2‐lesions (1‐year: β = 0.28, p = 0.03; 2‐year: β = 0.35, p = 0.01). Interpretation: A complete baseline MRI assessment and an accurate clinical and MRI monitoring during the first 2 years of disease contribute to predict 9‐year prognosis in pediatric patients with multiple sclerosis. ANN NEUROL 2021;89:1011–1022