Background

Cognitive impairment (CI) affects nearly 30% of paediatric patients with Multiple Sclerosis (MS) and has a negative impact on school performance and participation in social activities. This study is a re-appraisal of cognitive functioning and socio-professional attainment in adulthood in an Italian cohort of paediatric MS patients after 10 years from baseline neuropsychological assessment.

Objectives

To re-assess cognitive performance and its impact on socio-professional attainment in our cohort of paediatric MS patients after 10 years from baseline evaluation and to determine predictors of the individual outcomes.

Methods

Sixty-three paediatric patients were assessed at baseline and 48 followed-up after five years. To date, 31 out of these 48 patients (17 females, mean age 27.9±2.5 years, mean EDSS 1.7±1.6) were reassessed on an extensive neuropsychological battery and compared with a matched group of 31 healthy controls. CI was defined as the failure of > 2 tests. Socio-professional attainment was evaluated on the Work and Social Assessment Scale (WSAS). Predictors of CI and WSAS score were assessed through multivariable logistic and linear models.

Results

After a mean follow-up of 12.5±2.3 years, 15 (54%) subjects were classified as cognitively impaired. Patients with CI compared with those cognitively preserved at follow-up had higher Expanded Disability Status Scale (EDSS) score (1.9±1.4 vs 1.0±0.7; p = 0.046), lower baseline intelligence quotient (IQ) (86.2±23.8 vs 103.6±14.7; p = 0.025) and were less frequently treated with disease modifying therapy (DMT) at baseline [6 (35.3%) vs 11 (78.6%); p = 0.016]. In the regression model, CI after 10 years was related to lower IQ (OR 0.93, 95% CI 0.87-0.99, p = 0. 027) and absence of DMT at baseline assessment (OR 17.78 95%; 1.72-183.65, p = 0.017).

Baseline predictors of worse socio-professional attainment on the WSAS in adulthood were CI (B=6.3, p=0.016), higher EDSS (B=2.2, p=0.023) and higher age at onset (B=0.6, p=0.041). As for 10-year correlates, only CI was associated to poor functional outcome (B=5.2, p=0.006).

Conclusions

Complete data collection is ongoing; available findings to date show that in paediatric onset subjects CI remains significant in adulthood, is related to lower cognitive reserve, higher levels of neurological impairment and delay in DMT initiation. Moreover, CI plays a key role in predicting the subject social performance and professional outcome. Early treatment and promotion of strategies aimed at enhancing cognitive reserve are recommended in paediatric patients with MS.

Background

Background. No data are available on the occurrence of grey matter lesions (GML) in the cerebellum of pediatric multiple sclerosis (pedMS).

Objectives

Objectives. We analyzed frequency, number and topography of GML and their correlation with cerebellar-related disability in pedMS at clinical onset.

Methods

Methods. Fifteen adolescents with pedMS (12F/3M; mean age: 14.9±2.2, range 11–17) were studied. Neurological and cognitive evaluations were done by means of EDSS, Trail Making Test – Part B (TMT-B) and Symbol Digit Modalities Test – oral version (SDMT). Cerebellar GML were investigated with double inversion recovery (DIR) and phase sensitive inversion recovery (PSIR) sequences obtained with a 3T-MRI scan.

Results

Results. All patients had white matter lesions (WML) and/or GML in the cerebellum. A significantly higher GML number was observed on PSIR compared to DIR (mean: 2.3±2.3 vs 1.1±1.6; median: 2.0 (IQR, 1.0-2.0) vs 1.0 (IQR, 0.0-0.0.1); p=0.004). GML were observed in 14/15 (93.3%) patients and were more frequent in the posterior than in the anterior lobe (mean: 1.8±2.2 vs 0.47±0.74; median: 2.0 (IQR, 0.5-2.0) vs 0.0 (IQR, 0.0-1.0); p=0.044). No correlation was found between lesion number or topography and EDSS (r=0.12, p=0.69), TMT-B and SDMT.

Conclusions

Conclusions. At clinical onset, cerebellar GML are common in pedMS, are very often asymptomatic, do not correlate with physical and cognitive disability and more frequently affect the posterior lobe.