Pediatric-onset MS has greater cognitive toll

  • JAMA Neurol

  • International Clinical Digest
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Takeaway

  • In adulthood, patients with pediatric- vs adult-onset multiple sclerosis (MS) had poorer information-processing efficiency and were more likely to become cognitively impaired.

Why this matters

Key results

  • Median age at baseline: 25.6 years for patients with pediatric-onset MS, 38.3 years for patients with adult-onset MS.
  • In adjusted analysis, patients with pediatric-onset MS had lower Symbol Digit Modalities Test (SDMT) scores than patients with adult-onset MS (β coefficient, −3.59; 95% CI, −5.56 to −1.54).
  • The pediatric-onset group also had:
    • More rapid decline in SDMT scores (β coefficient, −0.30; 95% CI, −0.42 to −0.17).
    • Higher odds of cognitive impairment (OR, 1.44; 95% CI, 1.06-1.98).

Expert comment

  • In an editorial, Lauren B. Krupp, MD, and Leigh E. Charvet, PhD, write, “The increased awareness that children and adolescents can develop MS and that these individuals can experience cognitive and mood-related difficulties should help lead to more rapid interventions. A major advance in the management of MS has occurred with the advent of more effective treatments for individuals of all ages, and those with pediatric onset are being identified and treated more promptly than in the past. Additional research is necessary to determine whether these advances will lead to better long-term outcomes compared with those of patients treated in an earlier era.”

Study design

  • Swedish population-based longitudinal cohort study of patients initially aged 18-55 years, disease duration
  • 300 with pediatric-onset MS (onset
  • 5404 with adult-onset MS (onset ≥18 years of age).
  • Main outcome: information-processing efficiency measured every 6 or 12 months by SDMT over median 3.0-year follow-up.
  • Funding: Swedish Research Council; Swedish Brain Foundation; others.
  • Limitations

    • Single measure of cognition.
    • Possible practice effects.
    • Potential misclassification of onset.
    • Most patients treated.
    • Lack of information on highest educational level.