ADULT AND PEDIATRIC MULTIPLE SCLEROSIS: DIFFERENCES AND SIMILARITIES.

Mohamed Gomaa, Hossam Egila, Abdulhakim Mohammad, Ashraf El-Mitwalli and Mohamed El-Khateeb. Mansoura neurology department , Egypt. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 24 March 2019 Final Accepted: 26 April 2019 Published: May 2019 Background: Multiple sclerosis (MS) can occur in pediatric age group with prevalence rates ranging from 2.2%-4.4% of all MS cases. This research conducted to compare adult multiple sclerosis with pediatric multiple sclerosis clinically and radiologically and to assess similarities and differences between them. Methods: 30 MS patients divided into 2 groups (Group A aged 18 years or more at first presentation, group B less than 18 years) underwent detailed history taking, general , neurological examination, MRI brain for location and number of lesions and disability assessment using Expanded Disability Status Scale. Results: No significant difference between the two groups as regard duration of first attack, frequency between monosymptomatic to polysymptomatic and complete to partial to no improvement from first attack and percentage of frequency of each of all MRI locations. Conclusion: Pediatric and adult MS are similar as regard presentation ,progression and localization.


Patients
The study was conducted on thirty patients whom divided into two groups: Adult MS group: It includes 15 patients aged 18 years or more at first presentation, met the diagnostic criteria for adult MS And Pediatric MS group: It includes 15 patients aged less than 18 years at first presentation, met the diagnostic criteria for pediatric MS with maximal age at interview of 25 years.

Inclusion criteria For adult patients:
Patients fulfilled revised McDonald's criteria 2010 for diagnosis of multiple sclerosis.
For pediatric patients: 1. In patients aged 11 years or older and without ADEM presentations, they fulfilled revised McDonald's criteria 2010 for adult MS patients. 2. In patients aged less than 11 years or those with ADEM presentation, they fulfilled International Pediatric Multiple Sclerosis Study Group IPMSSG 2012 updated criteria for pediatric multiple sclerosis (Table-1).

Exclusion criteria
Radiologically isolated syndrome, clinically isolated syndrome, Presence of neurological or medical condition(s) that explain the clinical and radiological picture of the patient other than MS and Pediatric patients of age more than 25 years at time of the study. Methods:-

Results:-
The study was conducted on 30 patients with mean age of adult group was 35.7 ± 7.2 years and the mean age of pediatric group was 18.4 ± 4.5 years. There was no significant difference between adult and pediatric groups as regard percentage of frequency of male to female (P-value > 0.05). Table (2) The mean age at onset of adult group was 29.5 ± 5.54 years whereas in pediatric group was 14.3 ± 2.92 years. Time between first and second attack was found to be significantly higher in adult group when compared to pediatric group (P-values < 0.05) whereas there was no significant difference between adult and pediatric groups as regard of duration of first attack (P-value > 0.05). There was no significant difference between adult and pediatric groups as regard percentage of frequency between each of; mono symptomatic to polysymptomatic and complete to partial to no improvement from first attack (both P-values >0.05). Table (3) There was no significant difference between adult and pediatric groups as regard percentage of frequency of all types of symptoms of first attack (all P-values > 0.05). Table (4) There was no significant difference between adult and pediatric groups as regard EDSS scores and percentage of frequency of low disability to high disability (both P-values > 0.05). Table (5) There was a significant positive association between each of disease duration and secondary progressive versus relapsing remitting course as reference category and EDSS as an outcome in adult group (both P-values < 0.05). There was no significant association between each of age, male gender, age of onset, relapse rate, polysymptomatic presentation versus mono symptomatic as reference category and incomplete improvement from first attack versus complete improvement as reference category and EDSS as an outcome in adult group (all P-values > 0.05).
There was a significant positive association between each of incomplete improvement from first attack versus complete improvement as reference category and secondary progressive versus relapsing remitting course as reference category and EDSS as an outcome in pediatric group (both P-values < 0.05). There was no significant association between each of age, male gender, age of onset, disease duration, relapse rate and polysymptomatic presentation versus mono symptomatic as reference category and EDSS as an outcome in pediatric group (all Pvalues > 0.05). Table (6) There was no significant difference between adult and pediatric groups as regard percentage of frequency of each of all MRI locations (all P-values > 0.05). About spinal cord lesions, all of them had cervical region involvement, while 25% of adults (13.3% of all cases) and 20% of pediatric cases (6.7% of all cases) had dorsal involvement. One adult patient (6.7%) had tumefactive MS (large lesion > 2 cm).  Regarding type of presenting symptoms, our study demonstrated that no significant difference between adult and pediatric groups with predominance of optic, sensory and motor symptoms in both groups. Nobody presented with encephalopathy whereas seizures found in one pediatric patient (6.7%). Two adult (13.3%) and one pediatric (6.7%) patients presented with isolated transverse myelitis.
All pediatric patients in our study was having initial course of relapsing remitting type whereas 13.3% of them developed secondary progressive course. No body have primary progressive course in pediatric group. About 6.7% of adult group have primary progressive course, 20% have secondary progressive and 73.3% are still having relapsing remitting course. There was no statistical significant difference between both groups as regard the course of the disease (P-value = 0.651).
There was no significant difference between both groups in our study regarding EDSS scoring in with mean EDSS score of 3. Statistical analysis of distribution of MS lesions of the brain and spinal cord in this study, showed no significant difference between adult and pediatric patients. Infratentorial lesions were slightly more in pediatric cases whereas spinal cord lesions were slightly more in adult cases. The mean number of T2 lesions in brain MRI in our study was slightly more in pediatric patients than adults with statistical insignificant difference (12.53 in adult group versus 18 in pediatric group).
In a study of Chabaset al. (2008), pediatric MS patients had fewer brain MRI T2-bright foci and more frequent large MS lesions than with MS adults patients. However, recent studies show that onset in children with MS may have a higher lesion burden on their initial brain MRI scan than adults, especially those located in cerebellum and brainstem (Waubant&Chabas, 2009). Quantitative analysis of T2 lesion volumes in study of Ghassemi et al. (2008), in patients with paediatric-onset or adult-onset multiple sclerosis, who were imaged early in the disease and matched for disease duration, showed very similar T2 lesion volumes.