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Progress in the Management of Paediatric-Onset Multiple Sclerosis

Considerable progress has been made in the understanding and treatment of paediatric-onset multiple sclerosis (POMS); how this has translated into more effective care is less well understood. Here, we evaluate how recent advances have affected patient management and outcomes with a retrospective rev...

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Autores principales: Luchesa Smith, Aphra, Benetou, Christina, Bullock, Hayley, Kuczynski, Adam, Rudebeck, Sarah, Hanson, Katie, Crichton, Sarah, Mankad, Kshitij, Siddiqui, Ata, Byrne, Susan, Lim, Ming, Hemingway, Cheryl
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7695340/
https://www.ncbi.nlm.nih.gov/pubmed/33182341
http://dx.doi.org/10.3390/children7110222
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author Luchesa Smith, Aphra
Benetou, Christina
Bullock, Hayley
Kuczynski, Adam
Rudebeck, Sarah
Hanson, Katie
Crichton, Sarah
Mankad, Kshitij
Siddiqui, Ata
Byrne, Susan
Lim, Ming
Hemingway, Cheryl
author_facet Luchesa Smith, Aphra
Benetou, Christina
Bullock, Hayley
Kuczynski, Adam
Rudebeck, Sarah
Hanson, Katie
Crichton, Sarah
Mankad, Kshitij
Siddiqui, Ata
Byrne, Susan
Lim, Ming
Hemingway, Cheryl
author_sort Luchesa Smith, Aphra
collection PubMed
description Considerable progress has been made in the understanding and treatment of paediatric-onset multiple sclerosis (POMS); how this has translated into more effective care is less well understood. Here, we evaluate how recent advances have affected patient management and outcomes with a retrospective review of POMS patients managed at two paediatric neuroimmunology centres. Two cohorts, seen within a decade, were compared to investigate associations between management approaches and outcomes. Demographic, clinical and neurocognitive data were extracted from case notes and analysed. Of 51 patients, 24 were seen during the period 2007–2010 and 27 during the period 2015–2016. Median age at onset was 13.7 years; time from symptom onset to diagnosis was 9 months. Disease-modifying therapies were commenced in 19 earlier-cohort and 24 later-cohort patients. Median time from diagnosis to treatment was 9 months for earlier vs. 3.5 months in later patients (p = 0.013). A wider variety of treatments were used in the later cohort (four medications earlier vs. seven in the later and two clinical trials), with increased quality of life and neurocognitive monitoring (8% vs. 48% completed PedsQL quality of life inventory; 58% vs. 89% completed neurocognitive assessment). In both cohorts, patients were responsive to disease-modifying therapy (mean annualised relapse rate pre-treatment 2.7 vs. 1.7, mean post-treatment 0.74 vs. 0.37 in earlier vs. later cohorts). In conclusion, over the years, POMS patients were treated sooner with a wider variety of medications and monitored more comprehensively. However, this hugely uncontrolled cohort did not allow us to identify key determinants for the improvements observed.
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spelling pubmed-76953402020-11-28 Progress in the Management of Paediatric-Onset Multiple Sclerosis Luchesa Smith, Aphra Benetou, Christina Bullock, Hayley Kuczynski, Adam Rudebeck, Sarah Hanson, Katie Crichton, Sarah Mankad, Kshitij Siddiqui, Ata Byrne, Susan Lim, Ming Hemingway, Cheryl Children (Basel) Article Considerable progress has been made in the understanding and treatment of paediatric-onset multiple sclerosis (POMS); how this has translated into more effective care is less well understood. Here, we evaluate how recent advances have affected patient management and outcomes with a retrospective review of POMS patients managed at two paediatric neuroimmunology centres. Two cohorts, seen within a decade, were compared to investigate associations between management approaches and outcomes. Demographic, clinical and neurocognitive data were extracted from case notes and analysed. Of 51 patients, 24 were seen during the period 2007–2010 and 27 during the period 2015–2016. Median age at onset was 13.7 years; time from symptom onset to diagnosis was 9 months. Disease-modifying therapies were commenced in 19 earlier-cohort and 24 later-cohort patients. Median time from diagnosis to treatment was 9 months for earlier vs. 3.5 months in later patients (p = 0.013). A wider variety of treatments were used in the later cohort (four medications earlier vs. seven in the later and two clinical trials), with increased quality of life and neurocognitive monitoring (8% vs. 48% completed PedsQL quality of life inventory; 58% vs. 89% completed neurocognitive assessment). In both cohorts, patients were responsive to disease-modifying therapy (mean annualised relapse rate pre-treatment 2.7 vs. 1.7, mean post-treatment 0.74 vs. 0.37 in earlier vs. later cohorts). In conclusion, over the years, POMS patients were treated sooner with a wider variety of medications and monitored more comprehensively. However, this hugely uncontrolled cohort did not allow us to identify key determinants for the improvements observed. MDPI 2020-11-09 /pmc/articles/PMC7695340/ /pubmed/33182341 http://dx.doi.org/10.3390/children7110222 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Luchesa Smith, Aphra
Benetou, Christina
Bullock, Hayley
Kuczynski, Adam
Rudebeck, Sarah
Hanson, Katie
Crichton, Sarah
Mankad, Kshitij
Siddiqui, Ata
Byrne, Susan
Lim, Ming
Hemingway, Cheryl
Progress in the Management of Paediatric-Onset Multiple Sclerosis
title Progress in the Management of Paediatric-Onset Multiple Sclerosis
title_full Progress in the Management of Paediatric-Onset Multiple Sclerosis
title_fullStr Progress in the Management of Paediatric-Onset Multiple Sclerosis
title_full_unstemmed Progress in the Management of Paediatric-Onset Multiple Sclerosis
title_short Progress in the Management of Paediatric-Onset Multiple Sclerosis
title_sort progress in the management of paediatric-onset multiple sclerosis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7695340/
https://www.ncbi.nlm.nih.gov/pubmed/33182341
http://dx.doi.org/10.3390/children7110222
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