RT Journal Article
T1 Prognostic indicators in pediatric clinically isolated syndrome.
A1 Iaffaldano, Pietro
A1 Simone, Marta
A1 Lucisano, Giuseppe
A1 Ghezzi, Angelo
A1 Coniglio, Gabriella
A1 Brescia Morra, Vincenzo
A1 Salemi, Giuseppe
A1 Patti, Francesco
A1 Lugaresi, Alessandra
A1 Izquierdo, Guillermo
A1 Bergamaschi, Roberto
A1 Cabrera-Gomez, Jose Antonio
A1 Pozzilli, Carlo
A1 Millefiorini, Enrico
A1 Alroughani, Raed
A1 Boz, Cavit
A1 Pucci, Eugenio
A1 Zimatore, Giovanni Bosco
A1 Sola, Patrizia
A1 Lus, Giacomo
A1 Maimone, Davide
A1 Avolio, Carlo
A1 Cocco, Eleonora
A1 Sajedi, Seyed Aidin
A1 Costantino, Gianfranco
A1 Duquette, Pierre
A1 Shaygannejad, Vahid
A1 Petersen, Thor
A1 Fernández Bolaños, Ricardo
A1 Paolicelli, Damiano
A1 Tortorella, Carla
A1 Spelman, Tim
A1 Margari, Lucia
A1 Amato, Maria Pia
A1 Comi, Giancarlo
A1 Butzkueven, Helmut
A1 Trojano, Maria
A1 Italian iMedWeb Registry and the MSBase Registry, 
AB 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.
YR 2017
FD 2017
LK https://hdl.handle.net/10668/27665
UL https://hdl.handle.net/10668/27665
LA en
DS RISalud
RD Apr 6, 2025