Skip to main content
Passa alla visualizzazione normale.

GIUSEPPE SALEMI

Prognostic indicators in pediatric clinically isolated syndrome

  • Authors: Iaffaldano, Pietro; Simone, Marta; Lucisano, Giuseppe; Ghezzi, Angelo; Coniglio, Gabriella; Brescia Morra, Vincenzo; Salemi, Giuseppe; Patti, Francesco; Lugaresi, Alessandra; Izquierdo, Guillermo; Bergamaschi, Roberto; Cabrera-Gomez, Jose Antonio; Pozzilli, Carlo; Millefiorini, Enrico; Alroughani, Raed; Boz, Cavit; Pucci, Eugenio; Zimatore, Giovanni Bosco; Sola, Patrizia; Lus, Giacomo; Maimone, Davide; Avolio, Carlo; Cocco, Eleonora; Sajedi, Seyed Aidin; Costantino, Gianfranco; Duquette, Pierre; Shaygannejad, Vahid; Petersen, Thor; Fernández Bolaños, Ricardo; Paolicelli, Damiano; Tortorella, Carla; Spelman, Tim; Margari, Lucia; Amato, Maria Pia; Comi, Giancarlo; Butzkueven, Helmut; Trojano, Maria
  • Publication year: 2017
  • Type: Articolo in rivista (Articolo in rivista)
  • OA Link: http://hdl.handle.net/10447/358415

Abstract

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. INTERPRETATION: 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