Prognostic indicators of secondary progression in a paediatric-onset multiple sclerosis cohort in Kuwait
Affiliations
Affiliations
- Department of Community Medicine and Behavioural Sciences, University of Kuwait, Kuwait saeed.akhtar@hsc.edu.kw.
- Division of Neurology, Amiri Hospital, Kuwait/ Neurology Clinic, Dasman Diabetes Institute, Kuwait.
- Department of Neurology, Ibn Sina Hospital, Kuwait/ Department of Neurology and Psychiatry, Minia University, Egypt.
- Department of Neurology, Ibn Sina Hospital, Kuwait/ Department of Medicine, University of Kuwait, Kuwait.
Abstract
Background: The frequency of paediatric-onset multiple sclerosis (POMS) and the precise risk of secondary progression of disease are largely unknown in the Middle East. This cross-sectional cohort study assessed the risk and examined prognostic factors for time to onset of secondary progressive multiple sclerosis (SPMS) in a cohort of POMS patients.
Methods: The Kuwait National MS Registry database was used to identify a cohort of POMS cases (diagnosed at age <18 years) from 1994 to 2013. Data were abstracted from patients' records. A Cox proportional hazards model was used to evaluate the prognostic significance of the variables considered.
Results: Of 808 multiple sclerosis (MS) patients, 127 (15.7%) were POMS cases. The median age (years) at disease onset was 16.0 (range 6.5-17.9). Of 127 POMS cases, 20 (15.8%) developed SPMS. A multivariable Cox proportional hazards model showed that at MS onset, brainstem involvement (adjusted hazard ratio 5.71; 95% confidence interval 1.53-21.30; P=0.010), and POMS patient age at MS onset (adjusted hazard ratio 1.38; 95% confidence interval 1.01-1.88; P=0.042) were significantly associated with the increased risk of a secondary progressive disease course.
Conclusions: This study showed that POMS patients with brainstem/cerebellar presentation and a relatively higher age at MS onset had disposition for SPMS and warrant an aggressive therapeutic approach.
Keywords: Kuwait; Paediatric-onset multiple sclerosis; cross-sectional cohort study; hazard ratio; prognostic factors; secondary progression; survival analysis.
Similar articles
Long-term disability progression of pediatric-onset multiple sclerosis.
McKay KA, Hillert J, Manouchehrinia A.Neurology. 2019 Jun 11;92(24):e2764-e2773. doi: 10.1212/WNL.0000000000007647. Epub 2019 May 15.PMID: 31092624 Free PMC article.
Pediatric-Onset Multiple Sclerosis Disease Progression in Kuwait: A Retrospective Analysis.
Alroughani R, Ahmed SF, Al-Hashel J.Pediatr Neurol. 2015 Dec;53(6):508-12. doi: 10.1016/j.pediatrneurol.2015.06.010. Epub 2015 Jun 17.PMID: 26383244
Incidence and prevalence of pediatric onset multiple sclerosis in Kuwait: 1994-2013.
Alroughani R, Akhtar S, Ahmed SF, Behbehani R, Al-Abkal J, Al-Hashel J.J Neurol Sci. 2015;353(1-2):107-10. doi: 10.1016/j.jns.2015.04.025. Epub 2015 Apr 24.PMID: 25936254
Interrogating large multiple sclerosis registries and databases: what information can be gained?
Trojano M, Kalincik T, Iaffaldano P, Amato MP.Curr Opin Neurol. 2022 Jun 1;35(3):271-277. doi: 10.1097/WCO.0000000000001057.PMID: 35674068 Review.
Pediatric multiple sclerosis: developments in timely diagnosis and prognostication.
Margoni M, Preziosa P, Rocca MA, Filippi M.Expert Rev Neurother. 2022 May;22(5):393-403. doi: 10.1080/14737175.2022.2064743. Epub 2022 Apr 13.PMID: 35400266 Review.
Cited by
Impact of the first Gulf war on multiple sclerosis risk in Kuwait: a quasi-experimental study.
Akhtar S, Al-Hashel JY, Alroughani R.BMC Neurol. 2023 Jul 5;23(1):259. doi: 10.1186/s12883-023-03295-3.PMID: 37407920 Free PMC article.
Yang Y, Wang M, Xu L, Zhong M, Wang Y, Luan M, Li X, Zheng X.Front Neurol. 2022 Apr 29;13:874388. doi: 10.3389/fneur.2022.874388. eCollection 2022.PMID: 35572921 Free PMC article. Review.
Multiple Sclerosis in Children: Differential Diagnosis, Prognosis, and Disease-Modifying Treatment.
Jakimovski D, Awan S, Eckert SP, Farooq O, Weinstock-Guttman B.CNS Drugs. 2022 Jan;36(1):45-59. doi: 10.1007/s40263-021-00887-w. Epub 2021 Dec 23.PMID: 34940954 Free PMC article. Review.
Burtchell J, Fetty K, Miller K, Minden K, Kantor D.Neurol Ther. 2019 Dec;8(2):185-205. doi: 10.1007/s40120-019-0141-4. Epub 2019 Jul 4.PMID: 31273563 Free PMC article.
Improving Outcomes in Pediatric Multiple Sclerosis: Current and Emerging Treatments.
Wilbur C, Yeh EA.Paediatr Drugs. 2019 Jun;21(3):137-152. doi: 10.1007/s40272-019-00338-6.PMID: 31155694 Review.