The Multiple Sclerosis Prodrome in a Retrospective Pediatric Cohort

IF 3.2 3区医学 Q2 CLINICAL NEUROLOGY

Pediatric neurology Pub Date : 2024-09-10 DOI:10.1016/j.pediatrneurol.2024.09.005

Kelsey Barter MD , Siefaddeen Sharayah MD , Urmi Mange BA, Cristina M. Gaudioso MD, Natalie Schanzer BA, Connor Keuchel BA, Rachel Zolno MD, Soe Mar MD

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引用次数: 0

Abstract

Background

Evidence suggests a prodromal phase in multiple sclerosis (MS), with increased health care use preceding the first demyelinating event (FDE). Although prior studies have explored this in adults, limited data exist for pediatric cases. We aimed to analyze health care utilization and prodromal symptoms in the two years before FDE in patients with pediatric-onset MS (POMS).

Methods

From 122 patients at the Pediatric Multiple Sclerosis & Demyelinating Diseases Center at Washington University School of Medicine from 2011 to 2021, 37 POMS cases were identified. Of these, 21 with at least two years of records preceding FDE were included. Retrospective analysis covered symptoms and health care utilization in the two-year period before FDE, including ambulatory visits, hospital admissions, and office calls.

Results

Patients showed increased health care utilization in the year preceding FDE (period B; 96 interactions) compared with the prior year (period A; 77 interactions) and an increase in the percentage of neurology-related encounters (P < 0.001). There was an increase in all office calls from period A to period B (P = 0.01). Neurological complaints included headaches (28.6%), visual (19.0%), sensory (14.3%), and balance (14.3%) in the two years before FDE, and 28.6% of patients presented for psychiatric complaints. Common non-neurological complaints included infection, dermatologic, and musculoskeletal issues and injury.

Conclusions

Our POMS cohort showed increased health care use before FDE, consistent with population-based data. This study emphasizes diverse symptoms in prodromal POMS, with headaches being the most common neurological symptom in the two-year period before FDE.

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回顾性儿科队列中的多发性硬化前驱症状

背景：有证据表明，多发性硬化症（MS）有一个前驱期，在首次脱髓鞘事件（FDE）发生之前，医疗保健的使用会增加。尽管之前的研究已对成人病例进行了探讨，但儿科病例的数据却很有限。我们的目的是分析儿科多发性硬化症（POMS）患者在首次脱髓鞘前两年的医疗保健使用情况和前驱症状：从华盛顿大学医学院儿科多发性硬化症和脱髓鞘疾病中心2011年至2021年的122名患者中，确定了37例POMS病例。在这些病例中，有21例患者在患多发性硬化症之前至少有两年的病史记录。回顾性分析涵盖了FDE前两年期间的症状和医疗使用情况，包括门诊就诊、入院和诊室呼叫：结果：与前一年（A 期；77 次）相比，患者在 FDE 前一年（B 期；96 次互动）的医疗保健使用率有所增加，与神经病学相关的就诊比例也有所上升（P 结论：我们的 POMS 队列显示，在 FDE 前一年（B 期；96 次互动）的医疗保健使用率与前一年（A 期；77 次互动）相比有所上升：我们的 POMS 队列显示，FDE 前的医疗保健使用增加，这与基于人群的数据一致。本研究强调了POMS前驱期的各种症状，其中头痛是FDE前两年中最常见的神经系统症状。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric neurology 医学-临床神经学

CiteScore

4.80

自引率

2.60%

发文量

176

审稿时长

78 days

期刊介绍： Pediatric Neurology publishes timely peer-reviewed clinical and research articles covering all aspects of the developing nervous system. Pediatric Neurology features up-to-the-minute publication of the latest advances in the diagnosis, management, and treatment of pediatric neurologic disorders. The journal''s editor, E. Steve Roach, in conjunction with the team of Associate Editors, heads an internationally recognized editorial board, ensuring the most authoritative and extensive coverage of the field. Among the topics covered are: epilepsy, mitochondrial diseases, congenital malformations, chromosomopathies, peripheral neuropathies, perinatal and childhood stroke, cerebral palsy, as well as other diseases affecting the developing nervous system.