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Recent research examining MRI brain scans of children and adults with multiple sclerosis suggests that while MS is more aggressive in children, pediatric patients develop disabilities at a slower pace than patients with adult-onset MS.

U. BUFFALO (US)—MRI brain scans show that multiple sclerosis is more aggressive and causes more brain lesions in patients diagnosed in childhood. However, researchers report that disabilities develop at a slower pace compared to those diagnosed with MS as adults.

“Patients with pediatric-onset MS have three times as many relapses annually than patients with adult-onset disease, which suggests there is greater disease activity in this population,” says Bianca Weinstock-Guttman, associate professor of neurology at the University at Buffalo.

“But surprisingly, the average time to reach the secondary progressive phase of the disease is longer in patients who develop MS in childhood than in adult onset MS,” adds Weinstock-Guttman, who is corresponding author of the study published recently in the journal Brain. “Reaching the next stage of disability is almost 10 years longer in pediatric-onset patients.”

The National Multiple Sclerosis Society estimates that 8,000 to 10,000 children (defined as up to 18 years old) in the U.S. have multiple sclerosis, and another 10,000 to 15,000 have experienced at least one symptom suggestive of MS. The disease causes demyelination—destruction of the sheath that protects and insulates nerve fibers. Breaks in the myelin sheath disrupt the flow of electrical impulses, causing loss of sensation and coordination.

The UB study involved four sets of patients:

  • 17 children with an average age of 13.7 who were diagnosed with MS 2.7 years earlier
  • 33 adults with an average age of 36.5 years who were diagnosed with pediatric MS 20 years earlier
  • 81 adults with an average age of 40 who have had MS for an average of 2.6 years
  • 300 adults with an average age of 50.5 who’ve had MS for 20 years

All participants underwent a brain MRI scan and analysis measuring two types of brain tissue damage: T1-lesion volume, which shows “black holes,” or hypointense lesions, which are areas of permanent axonal damage; and T2-lesion volume, which shows the total number of lesions (lesion load) and overall disease burden.

Both of these measures indicated that MS is more aggressive in children in the early stages, says first author Eluen Yeh, assistant professor of neurology and codirector in the Pediatric Multiple Sclerosis Center.

“This corresponds with recent data that suggest a higher lesion burden in pediatric MS than adult-onset MS. These findings are somewhat surprising, considering we have assumed that children generally have a greater capacity for central nervous tissue repair.”

“Our findings, which are limited to a cross-sectional study design, suggest that children have a somewhat better reserve and functional adaptability than adults, but less support for a better remyelination process,” adds Weinstock-Guttman. “However, the remyelination process may require a more in-depth prospective analysis”

Weinstock-Guttman says the data support the need for early diagnosis and therapeutic intervention in pediatric MS patients.

The research was supported in part by grants from the National Multiple Sclerosis Society and Children’s Guild Foundation of Buffalo.

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