Published online September 1, 2006
PEDIATRICS Vol. 118 No. 3 September 2006, pp. 1133-1139 (doi:10.1542/peds.2006-0655)
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ARTICLE

Prognostic Factors for Early Severity in a Childhood Multiple Sclerosis Cohort

Yann Mikaeloff, MD, PhDa, Guillaume Caridade, MSca, Saada Assi, MDa, Samy Suissa, PhDb, Marc Tardieu, MD, PhDa on behalf of the KIDSEP Study Group

a Service de Neurologie Pédiatrique, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, INSERM U802, Paris, France
b Division of Clinical Epidemiology, McGill University and Royal Victoria Hospital, Montreal, Canada

OBJECTIVE. The goal was to identify prognostic factors for an early severe course in a cohort of patients with childhood-onset multiple sclerosis, for the construction of a predictive tool.

METHODS. The cohort consisted of 197 children from the French Kid Sclérose en Plaques neuropediatric cohort with relapsing/remitting multiple sclerosis beginning before the age of 16 years. Patients were included from 1990 to 2003. We used multivariate survival analysis (Cox model) to evaluate the prognostic value of clinical, MRI, and biological covariates at onset for the occurrence of a third attack or severe disability ("severity" outcome).

RESULTS. The cohort was monitored for a mean of 5.5 ± 3.6 years. The "severity" outcome was recorded for 144 patients (73%). The risk of severity was higher for girls, for a time between the first and second attacks of <1 year, for childhood-onset multiple sclerosis MRI criteria at onset, for an absence of severe mental state changes at onset, and for a progressive course. A derived childhood-onset multiple sclerosis potential index for early severity was found to have a positive predictive value for severity of >35% for the upper 2 quartiles.

CONCLUSIONS. The clinical and MRI prognostic factors for early severity that were identified were used as the basis of a predictive tool, which will be validated in another cohort. This tool should make it possible to identify subgroups at risk of early severe disease and should facilitate therapeutic studies.

Key Words: children • multiple sclerosis • cohort • multivariate analysis • survival analysis

Abbreviations: A1—first attack • A2—second attack • A3—third attack • MS—multiple sclerosis • DSS—disability status scale

Accepted May 5, 2006.




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