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. 2016 Feb;22(2):193-200.
doi: 10.1177/1352458515581873. Epub 2015 May 6.

Menarche increases relapse risk in pediatric multiple sclerosis

Sabeen Lulu  1 , Jennifer Graves  2 , Emmanuelle Waubant  2
Affiliations

Menarche increases relapse risk in pediatric multiple sclerosis

Sabeen Lulu et al. Mult Scler. 2016 Feb.

Abstract

Background: Multiple sclerosis (MS) predominantly affects women with a sex ratio of 3:1 in contrast with a 1:1 sex ratio seen in pre-pubertal onset. Thus, puberty may influence MS risk differentially in males and females. How puberty may be associated with MS clinical features and disease course remains unknown.

Objective: The objective of this paper is to determine the association of menarche with disease course in girls with MS.

Methods: This is a longitudinal retrospective study from the UCSF Regional Pediatric MS Center database. We categorized patients by time of disease onset: pre-menarche, peri-menarche and post-menarche. Poisson regression models were used for within-subject relapse analyses offset by follow-up time.

Results: Seventy-six girls were included (pre-menarche onset = 17; peri-menarche onset = 9; post-menarche onset = 50). Age of menarche was similar in all groups (Kruskal-Wallis p = 0.19). Relapse rate was the same in all three groups during the first two years of follow-up. In girls with follow-up overlapping at least two time periods, within-subject analyses showed increased relapses during the peri-menarche compared to post-menarche period (adjusted IRR = 8.5, 95% CI 2.5-28.7, p = 0.001).

Conclusion: Pubertal status may influence MS course at least in female patients. Understanding how puberty influences MS clinical features may offer new insights into important factors regulating disease processes.

Keywords: Multiple sclerosis; outcome measurement; relapsing–remitting.

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Figures

Figure 1
Figure 1. Menarche and time of disease onset in girls with pediatric multiple sclerosis at the University of California, San Francisco
This graph shows the three time epochs of menarche; pre-menarche, peri-menarche and post-menarche. The time of their first demyelinating event is represented by the beginning of the arrow. A total of 17 girls had pre-menarche onset of their first demyelinating event, of which nine girls have not yet experienced menarche at the time of their last visit. Eight girls with pre-menarche onset were followed up through peri-menarche period and post-menarche period. A total of nine girls had onset of symptoms within six months of menarche (peri-menarche); Seven before and two after. The majority of our patients (50 girls) had their first demyelinating event after menarche.
Figure 2
Figure 2. Time of first demyelinating event from menarche
This is a histogram showing the time in years of the first demyelinating event and onset of menarche in 60 girls with pediatric MS. Nine patients who have not yet reached menarche are not included. Median time of first demyelinating event was 2.2 years after menarche. Time less than zero indicates onset prior to menarche.
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