%0 Journal Article
%A Iaffaldano, Pietro
%A Simone, Marta
%A Lucisano, Giuseppe
%A Ghezzi, Angelo
%A Coniglio, Gabriella
%A Brescia Morra, Vincenzo
%A Salemi, Giuseppe
%A Patti, Francesco
%A Lugaresi, Alessandra
%A Izquierdo, Guillermo
%A Bergamaschi, Roberto
%A Cabrera-Gomez, Jose Antonio
%A Pozzilli, Carlo
%A Millefiorini, Enrico
%A Alroughani, Raed
%A Boz, Cavit
%A Pucci, Eugenio
%A Zimatore, Giovanni Bosco
%A Sola, Patrizia
%A Lus, Giacomo
%A Maimone, Davide
%A Avolio, Carlo
%A Cocco, Eleonora
%A Sajedi, Seyed Aidin
%A Costantino, Gianfranco
%A Duquette, Pierre
%A Shaygannejad, Vahid
%A Petersen, Thor
%A Fernández Bolaños, Ricardo
%A Paolicelli, Damiano
%A Tortorella, Carla
%A Spelman, Tim
%A Margari, Lucia
%A Amato, Maria Pia
%A Comi, Giancarlo
%A Butzkueven, Helmut
%A Trojano, Maria
%A Italian iMedWeb Registry and the MSBase Registry
%T Prognostic indicators in pediatric clinically isolated syndrome.
%D 2017
%U https://hdl.handle.net/10668/27665
%X To assess prognostic factors for a second clinical attack and a first disability-worsening event in pediatric clinically isolated syndrome (pCIS) suggestive of multiple sclerosis (MS) patients. A cohort of 770 pCIS patients was followed up for at least 10 years. Cox proportional hazard models and Recursive Partitioning and Amalgamation (RECPAM) tree-regression were used to analyze data. In pCIS, female sex and a multifocal onset were risk factors for a second clinical attack (hazard ratio [HR], 95% confidence interval [CI] = 1.28, 1.06-1.55; 1.42, 1.10-1.84, respectively), whereas disease-modifying drug (DMD) exposure reduced this risk (HR, 95% CI = 0.75, 0.60-0.95). After pediatric onset MS (POMS) diagnosis, age at onset younger than 15 years and DMD exposure decreased the risk of a first Expanded Disability Status Scale (EDSS)-worsening event (HR, 95% CI = 0.59, 0.42-0.83; 0.75, 0.71-0.80, respectively), whereas the occurrence of relapse increased this risk (HR, 95% CI = 5.08, 3.46-7.46). An exploratory RECPAM analysis highlighted a significantly higher incidence of a first EDSS-worsening event in patients with multifocal or isolated spinal cord or optic neuritis involvement at onset in comparison to those with an isolated supratentorial or brainstem syndrome. A Cox regression model including RECPAM classes confirmed DMD exposure as the most protective factor against EDSS-worsening events and relapses as the most important risk factor for attaining EDSS worsening. This work represents a step forward in identifying predictors of unfavorable course in pCIS and POMS and supports a protective effect of early DMD treatment in preventing MS development and disability accumulation in this population. Ann Neurol 2017;81:729-739.
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