Clinical predictors of relapse in children with the first demyelinating event
ECTRIMS Online Library. Nevmerzhitskaya K. 09/13/19; 278313; P1111
Kristina Nevmerzhitskaya
Kristina Nevmerzhitskaya
Contributions
Abstract

Abstract: P1111

Type: Poster Sessions

Abstract Category: Clinical aspects of MS - Paediatric MS

K. Nevmerzhitskaya1, L. Volkova1, A. Sergeev2,3

1Department of Neurology, Ural State Medical University, 2Institute of Radio-Electronics and IT, Ural Federal University, 3Laboratory of Physics and Ecology, Institute of Industrial Ecology UB RAS, Ekaterinburg, Russian Federation

Introduction: The course of demyelinating diseases (DD) of the central nervous system (CNS) in childhood is monophasic or remitting.
Objectives: aim of this study was to evaluate the features of the first demyelinating event (FDE) that can predict relapsing course of DD in children.
Methods: Observational cohort study was performed during 1999-2018. All the patients have the first episode of focal neurological dysfunction with a presumed demyelinating cause. Neurological status, magnetic resonance imaging (MRI) and second relapse risk were evaluated. Fisher exact test, Mann-Whitney U test, relative risk (RR) were used for statistical analysis.
Results: 75 children (46 girls, 29 boys; age median 12 years) with the FDE were identified. 60 patients (80%) have monofocal neurological presentation. Initial symptoms were optic neuritis (n=36), transverse myelitis (TM) (n=15), brainstem syndrome (n=14), cerebellar disorder (n=13), motor (n=13) and sensor (n=4) dysfunction. Five patients have encephalopathy. Abnormal brain and/or spinal MRIs presented with single (n=11) and multiple (n=40) T2-hyperintense demyelinating lesions was obtained in 51 patients (68%).
Mean follow-up duration was 5,2±4years (range 0.5:17 years). 42 (56%) of the patients had second attack after 1 to 60 months (median 8.5 months). During follow-up period 1-14 (median 3) relapses were registered. The final diagnosis was multiple sclerosis in 32 patients, relapsing optic neuritis - in 7, polyphasic acute disseminated encephalomyelitis - in 2, neuromyelitis optica - in 1 patient.
The older age (≥11 y.o.) at the initial event correlated with relapse outcome (RR=2,61; 95%Cl 1,42:4,79) as well asclinical presentation with brainstem syndrome (RR=10,21; 95%Cl 1,41:74,14) and partial TM (RR=3,43; 95%Cl 1,04:11,82). MRI predictors were: number of lesions >5 (RR=3,18; 95% CI 1,18:8,58), periventricular (RR=2,55; 95% CI 1,3:4,97), subcortical (RR=1,97; 95% CI 1,29:2,9) and brainstem (RR=1,9; 95% CI 1,17:2,95) localisations of the lesions, well-defined lesions (RR=1,76; 95% CI 1,05:3,16), Dawson fingers sign (RR=1,85; 95% CI 1,38:2,49), lateralised spinal lesions (RR=3,5; 95% CI1,02:11,96).
Conclusions: The study showed that children with the FDE were found to have a 65% risk for relapsing. The age, brainstem, partial spinal signs and polyfocal specific MRI presentation at onset may determine the long-term prognosis of relapse outcome.
Disclosure: Kristina Nevmerzhitskaya: nothing to discloser
Larisa Volkova: nothing to discloser
Alexander Sergeev: nothing to discloser

Abstract: P1111

Type: Poster Sessions

Abstract Category: Clinical aspects of MS - Paediatric MS

K. Nevmerzhitskaya1, L. Volkova1, A. Sergeev2,3

1Department of Neurology, Ural State Medical University, 2Institute of Radio-Electronics and IT, Ural Federal University, 3Laboratory of Physics and Ecology, Institute of Industrial Ecology UB RAS, Ekaterinburg, Russian Federation

Introduction: The course of demyelinating diseases (DD) of the central nervous system (CNS) in childhood is monophasic or remitting.
Objectives: aim of this study was to evaluate the features of the first demyelinating event (FDE) that can predict relapsing course of DD in children.
Methods: Observational cohort study was performed during 1999-2018. All the patients have the first episode of focal neurological dysfunction with a presumed demyelinating cause. Neurological status, magnetic resonance imaging (MRI) and second relapse risk were evaluated. Fisher exact test, Mann-Whitney U test, relative risk (RR) were used for statistical analysis.
Results: 75 children (46 girls, 29 boys; age median 12 years) with the FDE were identified. 60 patients (80%) have monofocal neurological presentation. Initial symptoms were optic neuritis (n=36), transverse myelitis (TM) (n=15), brainstem syndrome (n=14), cerebellar disorder (n=13), motor (n=13) and sensor (n=4) dysfunction. Five patients have encephalopathy. Abnormal brain and/or spinal MRIs presented with single (n=11) and multiple (n=40) T2-hyperintense demyelinating lesions was obtained in 51 patients (68%).
Mean follow-up duration was 5,2±4years (range 0.5:17 years). 42 (56%) of the patients had second attack after 1 to 60 months (median 8.5 months). During follow-up period 1-14 (median 3) relapses were registered. The final diagnosis was multiple sclerosis in 32 patients, relapsing optic neuritis - in 7, polyphasic acute disseminated encephalomyelitis - in 2, neuromyelitis optica - in 1 patient.
The older age (≥11 y.o.) at the initial event correlated with relapse outcome (RR=2,61; 95%Cl 1,42:4,79) as well asclinical presentation with brainstem syndrome (RR=10,21; 95%Cl 1,41:74,14) and partial TM (RR=3,43; 95%Cl 1,04:11,82). MRI predictors were: number of lesions >5 (RR=3,18; 95% CI 1,18:8,58), periventricular (RR=2,55; 95% CI 1,3:4,97), subcortical (RR=1,97; 95% CI 1,29:2,9) and brainstem (RR=1,9; 95% CI 1,17:2,95) localisations of the lesions, well-defined lesions (RR=1,76; 95% CI 1,05:3,16), Dawson fingers sign (RR=1,85; 95% CI 1,38:2,49), lateralised spinal lesions (RR=3,5; 95% CI1,02:11,96).
Conclusions: The study showed that children with the FDE were found to have a 65% risk for relapsing. The age, brainstem, partial spinal signs and polyfocal specific MRI presentation at onset may determine the long-term prognosis of relapse outcome.
Disclosure: Kristina Nevmerzhitskaya: nothing to discloser
Larisa Volkova: nothing to discloser
Alexander Sergeev: nothing to discloser

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