Characteristics of Children and Adolescents With Multiple Sclerosis

Abstract

Objectives: To describe the demographic and clinical characteristics of pediatric multiple sclerosis (MS) in the United States.

Methods: This prospective observational study included children and adolescents with MS. Cases were evaluated across 9 geographically diverse sites as part of the US Network of Pediatric MS Centers.

Results: A total of 490 children and adolescents (324 girls, 166 boys) were enrolled; 28% developed symptoms before 12 years of age. The proportion of girls increased with age from 58% (<12 years) to 70% (≥12 years). Race and ethnicity as self-identified were: white, 67%; African American, 21%; and non-Hispanic, 70%. Most (94%) of the cases were born in the United States, and 39% had 1 or both foreign-born parents. Fifty-five percent of cases had a monofocal presentation; 31% had a prodrome (most frequently infectious), most often among those aged <12 years (P < .001). Children aged <12 years presented more commonly with encephalopathy and coordination problems (P < .001). Sensory symptoms were more frequently reported by older children (ie, those aged ≥12 years) (P < .001); 78% of girls had MS onset postmenarche. The initial Expanded Disability Status Scale score for the group was <3.0, and the annualized relapse rate was 0.647 for the first 2 years. Interval from symptom onset to diagnosis and from diagnosis to initiation of disease-modifying therapy was longer among those <12 years of age.

Conclusions: Pediatric MS in the United States is characterized by racial and ethnic diversity, a high proportion of children with foreign-born parents, and differences in clinical features and timing of treatment among those <12 years of age compared with older children.

FIGURE 1

Age distribution, according to sex, of pediatric-onset MS patients at the time of first event.

FIGURE 2

Country of birth among pediatric-onset MS patients and their parents. Patients (n = 27) and parents (n = 102) with missing birth country data are excluded. Countries are categorized as follows: Central and South America: Argentina, Brazil, Chile, Colombia, Ecuador, El Salvador, French Guiana, Guatemala, Guyana, Mexico, Nicaragua, Panama, Peru, Suriname, and Venezuela; Caribbean: Antigua, Bahamas, Barbados, Dominican Republic, Grenada, Haiti, Jamaica, Puerto Rico, Virgin Islands, and West Indies; Asia: Afghanistan, China, Hong Kong, India, Pakistan, Philippines, South Korea, Taiwan, Vietnam, and Asia otherwise unknown; Europe: Albania, Bosnia, England, United Kingdom, Germany, Italy, Netherlands, Portugal, Russia, and Serbia; Middle East: Iran, Israel, Jordan, Saudi Arabia, United Arab Emirates, and Yemen; North America other: Bermuda and Canada; Other (Africa, Oceania): Cape Verde, Egypt, Fiji, Liberia, Libya, Nigeria, Tunisia, and Outside the United States otherwise unknown.