• Brenda Banwell, Lauren Krupp, Julia Kennedy, Raymond Tellier, Silvia Tenembaum, Jayne Ness, Anita Belman, Alexei Boiko, Olga Bykova, Emmanuelle Waubant, Jean K Mah, Cristina Stoian, Marcelo Kremenchutzky, Maria Rita Bardini, Martino Ruggieri, Mary Rensel, Jin Hahn, Bianca Weinstock-Guttman, YehE AnnEA, Kevin Farrell, Mark Freedman, Matti Iivanainen, Meri Sevon, Virender Bhan, Marie-Emmanuelle Dilenge, Derek Stephens, and Amit Bar-Or.
• Division of Neurology, The Hospital for Sick Children, University of Toronto, ON, Canada. brenda.banwell@sickkids.ca
• Lancet Neurol. 2007 Sep 1; 6 (9): 773-81.

BackgroundThe full spectrum of clinical manifestations and outcome, and the potential importance of regional or demographic features or viral triggers in paediatric multiple sclerosis (MS), has yet to be fully characterised. Our aim was to determine some of these characteristics in children with MS.Methods137 children with MS and 96 control participants matched by age and geographical region were recruited in a multinational study. They underwent structured clinical-demographic interviews, review of academic performance, physical examination, disability assessment (MS patients only), and standardised assays for IgG antibodies directed against Epstein-Barr virus, cytomegalovirus, parvovirus B19, varicella zoster virus, and herpes simplex virus.FindingsMS was relapsing-remitting at diagnosis in 136 (99%) children. The first MS attack resembled acute disseminated encephalomyelitis (ADEM) in 22 (16%) of the children, most under 10 years old (mean age 7.4 [SD 4.2] years). Children with ADEM-like presentations were significantly younger than were children with polyfocal (11.2 [4.5] years; p<0.0001) or monofocal (12.0 [3.8] years; p=0.0005) presentations. Permanent physical disability (EDSS>or=4.0) developed within 5 years in 15 (13%) of the 120 children for whom EDSS score was available. 23 (17%) had impaired academic performance, which was associated with increasing disease duration (p=0.02). Over 108 (86%) of the children with MS, irrespective of geographical residence, were seropositive for remote EBV infection, compared with only 61 (64%) of matched controls (p=0.025, adjusted for multiple comparisons). Children with MS did not differ from controls in seroprevalence of the other childhood viruses studied, nor with respect to month of birth, sibling number, sibling rank, or exposure to young siblings.InterpretationPaediatric MS is a relapsing-remitting disease, with presenting features that vary by age at onset. MS in children might be associated with exposure to EBV, suggesting a possible role for EBV in MS pathobiology.

32 keywords...

hide…