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More MS news articles for February 2004

First episode of acute CNS inflammatory demyelination in childhood: Prognostic factors for multiple sclerosis and disability

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14760270&dopt=Abstract

J Pediatr. 2004 Feb;144(2):246-52
Mikaeloff Y, Suissa S, Vallee L, Lubetzki C, Ponsot G, Confavreux C, Tardieu M, Kidmus Study Group.
Service de Neurologie Pediatrique, Hopital Roger Salengro, Lille, France.

OBJECTIVES:

To evaluate prognostic factors for second attack and for disability in children presenting with an initial episode of central nervous system (CNS) demyelination.

STUDY DESIGN:

A cohort of 296 children having a first episode of acute CNS inflammatory demyelination was studied by survival analysis.

RESULTS:

The average follow-up was 2.9+/-3 years.

At the end of the follow-up, 57% of patients had a diagnosis of multiple sclerosis (MS), 29% had a monophasic acute disseminated encephalomyelitis, and 14% had a single focal episode.

The rate of a second attack was (1) higher in patients with age at onset >/=10 years (hazard ratio, 1.67; 95% CI, 1.04-2.67), MS-suggestive initial MRI (1.54; 1.02-2.33), or optic nerve lesion (2.59; 1.27-5.29); and (2) lower in patients with myelitis (0.23; 0.10-0.56) or mental status change (0.59; 0.33-1.07).

Of patients with a second attack, 29% had an initial diagnosis of acute disseminated encephalomyelitis.

At the end of the follow-up period, 90% of patients had no or minor disability.

Occurrence of severe disability was associated with a polysymptomatic onset (3.25; 1.16-11.01), sequelae after the first attack (26.65; 9.42-75.35), further relapses (1.49; 1.16-1.92), and progressive MS (3.57; 1.21-8.72).

CONCLUSIONS:

Risk of second attack of CNS demyelination is higher in older patients and lower in patients with mental status change.

Risk of disability is higher in polysymptomatic and relapsing patients.