Multiple Skleroz Tanılı Çocukların Demografik ve Klinik Özelliklerinin Retrospektif Olarak Değerlendirilmesi

Abstract

Amaç: Bu retrospektif çalışma, multiple skleroz (MS) tanısı ile izlenen çocuk ve adölesan hastaların demografik ve klinik özelliklerini sunmak amacıyla yapılmıştır. Yöntem: Araştırma verileri, 10-25 Aralık 2021 tarihleri arasında İzmir’de bulunan üç hastanede izlenen pediatrik MS tanılı olguların, demografik verileri, başvuru yakınmaları, klinik bulguları veuygulanan tedavileri veri toplama formu ile retrospektif olarak elde edilmiştir. Bulgular: Bu retrospektif çalışmada 40 hastanın verileri incelenmiştir. Hastaların %77,5’i kız, yaş ortalaması 16 yaş ± 2,3 ve ilk atak yaş ortalaması 13,9 yaş olarak bulunmuştur. Hastaların yaklaşık yarısı interferon beta 1a subkutan, %27,5’i glatiramer asetat tedavisi aldığı ve ilaç kullanım sürelerinin ortalama 18 ay olduğu görülmüştür. Hastaların %20’si ise herhangi bir tedavi almamıştır. Tedavi alan hastaların %31,2’si ilaçtan dolayı yan etki yaşamış ve %15,6’sı yan etki nedeniyle tedaviye uyum sağlayamamıştır. Uyum sağlayamayan tüm hastaların tedavileri değiştirilmiştir. Çalışmada 3 olguda ailesel MS hastalığı öyküsü bulunmaktadır. Hastaların %72,5’i ilk ataklarında 3-10 gün intravenöz metilprednizolon tedavisi almış, tedavi alanların yarısından fazlası (%79,2) metilprednizolon tedavisi sonrası tama yakın/tamamen düzelme sağlamıştır. Hastaların %80’i relapsing-remitting MS ve %20’si klinik/radyolojik izole sendrom formundadır. Sonuç: Çocukluk çağında MS hastalığı, kızlarda daha sık ve en sık relapsing-remitting formunda görülmektedir. Çocukluk çağı MS tedavisinde büyük oranda interferon beta 1a ve glatiramer asetat kullanılmaktadır. İmmünomodülatör tedavi ile atak sayısında azalma, genişletilmiş özürlülük durum ölçeği puan ortalamasında düşme ile iyilik hali sağlanabilmektedir.

Keywords

• adölesan
• multiple skleroz
• retrospektif
• Çocuk

Supporting Institution

Yoktur.

Project Number

Yoktur.

Thanks

Yoktur.

Retrospective Evaluation of Demographic and Clinical Characteristics of Children with Multiple Sclerosis

Abstract

Objective: This retrospective study was conducted to present the clinical features and treatment experiences of child and adolescent patients diagnosed with multiple sclerosis (MS). Methods: Demographic data, current complaints and clinical findings of patients in addition to treatment modalities applied and compliance of pediatric patients with MS to treatments were evaluated retrospectively in the context of a data collection form. Results: The data of 40 patients were analyzed in this retrospective study. Of our patients 77.5% were female and the mean age of participants was 16 and the mean of age when patients experienced the first attack was 13.9% approximately half of our patients were receiving interferon beta 1a subcutaneously and 27.5% were receiving glatiramer acetate and their mean duration of use was 18 months. The ratio of patients who did not receive any treatment was 20%. Of the patients receiving treatment, 31.2% experienced side effects due to the drug and 15.6% could not comply with the treatment because of side effects of treatment. The treatment of all patients who failed to comply with the current treatment was changed. In our study, there was a family history of MS in 3 cases. Of patients, 72.5% received intravenous methylprednisolone treatment for between 3 and 10 days during the the first episodes of their illness, and more than half (79.2%) of the patients got completely or nearly completely better. Of patients, 80% had relapsing-remitting MS and 20% had clinical / radiological isolated syndrome. Conclusion: Childhood MS is seen more commonly in girls and the most frequently in the relapsing-remitting form. Interferon beta 1a and glatiramer acetate are mostly used in the treatment of childhood MS. With immunomodulatory treatment, a decrease both in the number of attacks and in the average expanded disability status scale score, besides an improvement for health can be provided.

Keywords

• Child
• adolescent
• multiple sclerosis
• retrospective

Project Number

Yoktur.

References

1. Duignan S, Brownlee W, Wassmer E, Hemingway C, Lim M, Ciccarelli O, et al. Paediatric multiple sclerosis: a new era in diagnosis and treatment. DMCN 2019; 61: 1039–1049. doi: 10.1111/dmcn.14212
2. Spiro DB. Early onset Multiple Sclerosis: A review for nurse practitioners. J Pediatr Heal Care. 2012; 26 (6): 399–408. http://dx.doi.org/10.1016/j.pedhc.2011.02.006
3. Hebert D, Geisthardt C, Hoffman H. Insights and recommendations from parents receiving a diagnosis of pediatric multiple sclerosis for their child. J Child Neurol. 2019; 34(8): 464–71. https://doi.org/10.1177%2F0883073819842420
4. Ünsal MA. Trial of fingolimod versus ınterferon beta-1a in pediatric Multiple Sclerosis. Turk J Neurol. 2019; 25:50-51. doi: 10.4274/tnd.galenos.2019.00187
5. Chitnis T, Arnold DL, Banwell B, Brück W,Ghezzi A, Giovannoni , et al. Trial of fingolimod versus interferon beta-1a in pediatric Multiple Sclerosis. N Engl J Med. 2018;379(11):1017-1027. doi:10.1056/NEJMoa1800149
6. Reinhardt K, Weiss S, Rosenbauer J, Gärtner J, Von Kries R. Multiple sclerosis in children and adolescents: Incidence and clinical picture - new insights from the nationwide German surveillance (2009-2011). Eur J Neurol. 2014;21(4):654–9. https://doi.org/10.1111/ene.12371
7. Renoux C, Vukusic S, Mikaeloff Y, Edan G, Clanet M, Dubois B, et al. Natural history of multiple sclerosis with childhood onset. N Engl J Med. 2007;356(25):2603–13.
8. Yılmaz Ü, Anlar B, Gücüyener K, Yaramış A, Cansu A, Ünalp A, et al. Characteristics of pediatric multiple sclerosis: The Turkish pediatric multiple sclerosis database. Eur J Paediatr Neurol. 2017;21(6):864–7

9. Ghezzi A, Amato MP, Annovazzi P, Capobianco M, Gallo P, La Mantia L, et al. Long-term results of immunomodulatory treatment in children and adolescents with Multiple Sclerosis: The Italian experience. Neurol Sci. 2009;30(3):193–9. https://doi.org/10.1007/s10072-009-0083-1
10. Banwell BL, Anderson PE. The cognitive burden of multiple sclerosis in children. Neurology 2005; 64: 891-894.
11. Alroughani R, Boyko A. Pediatric Multiple Sclerosis: A review. BMC Neurol. 2018;18(1):4–11. https://doi.org/10.1186/s12883-018-1026-313.
12. Banwell B, Krupp L, Kennedy J, Tellier R, Tenembaum S, Ness J, et al. Clinical features and viral serologies in children with multiple sclerosis: a multinational observational study. Lancet Neurol. 2007;6(9):773–81. https://doi.org/10.1016/s1474-4422(07)70196-5
13. Bettencourt A, Boleixa D, Reguengo H, Samões R, Santos E, Oliveira JC, et al. Serum 25-hydroxyvitamin D levels in multiple sclerosis patients from the north of Portugal. J Steroid Biochem Mol Biol. 2018;180(228):137–41. https://doi.org/10.1016/j.jsbmb.2017.09.016
14. Graves SJ, Chitnis T, Weinstock-Guttman B, et al. Maternal and perinatal exposures are associated with risk for pediatric-onset multiple sclerosis. Pediatrics. 2017;139 (4): e20162838 doı: https://doi.org/10.1542/peds.2016-2838
15. Banwell BL. Through the eyes of a child: Research insights gained through the study of childhood multiple sclerosis. Mult Scler. 2008;14(1):4–5. https://doi.org/10.1177/1352458507084266
16. Lublin FD, Reingold SC, Cohen JA, et al. Defining the clinical course of multiple sclerosis: the 2013 revisions. Neurology. 2014;83(3):278-286. doi:10.1212/WNL.0000000000000560
17. Ünal A, Mavioğlu H, Altunrende B, İçen KN, Ergün U. Multipl sklerozda tanı ve ayırıcı tanı. İçinde: Efendi H, Yandım KD, editörler. Multipl Skleroz Tanı ve Tedavi Kılavuzu. İstanbul, Türkiye:Türk Nöroloji Derneği; 2018: 9-29.
18. Ghezzi A. Therapeutic strategies in childhood multiple sclerosis. Ther Adv Neurol Disord. 2010;3(4):217–28. https://doi.org/10.1177/1756285610371251
19. Robertson NP, Fraser M, Deans J, Clayton D, Walker N, Compston DAS. Age-adjusted recurrence risks for relatives of patients with multiple sclerosis. Brain. 1996;119(2):449–55. https://doi.org/10.1093/brain/119.2.449
20. İlki D C, Gündüz T, Kürtüncü M, Yapıcı Z, Sencer S, Eraksoy M. Ataklı yineleyici multipl sklerozlu çocuklarda fingolimod tedavisi: gerçek yaşam verisi. Turk J Neurol. 2020; 26: 34-38 DOI:10.4274/tnd.2019.77010
21. Rensel M. Long-term treatment strategies of pediatric multiple sclerosis, ıncluding the use of disease modifying therapies. Children (Basel). 2019;6(6):73. doi:10.3390/children606007326.
22. Erbay Ö, Yeşilbalkan UÖ, Yüceyar A. Factors affecting the compatibility of disease-modifying drug treatment for patients with Multiple Sclerosis. DEUHFED.2018; 11 (2): 164-172
23. Conk Z, Başbakkal Z, Yardımcı F. Çocuk sağlığına genel bakış. İçinde: Conk Z, Başbakkal Z, Yılmaz BH, Bolışık B, editörler. Pediatri Hemşireliği. 2. Baskı. Ankara: Akademisyen Tıp Kitabevi; 2018: 33-43.
24. Forrester MB, Coleman L, Kornberg AJ. Multiple sclerosis in childhood: Clinical and radiological features. J Child Neurol. 2009;24(1):56–62 https://doi.org/10.1177/0883073808321042
25. Kamaşık T, Cansu A, Acar AE, Şahin S, Diler DB, Dilber B, et al. A comparison of pediatric- and adult-onset Multiple Sclerosis. Turkiye Klin J Neurol. 2017;12(3):57–63.
26. Belman AL, Krupp LB, Olsen CS, Rose JW, Aaen G, Benson L, et al. Characteristics of children and adolescents with multiple sclerosis. Pediatrics. 2016;138(1).
27. Özakbaş S. Childhood onset Multiple Sclerosis: Clinical Features, diagnostic approaches and therapeutic features. Turkiye Klinikleri J Neurol-Special Topics. 2009;2(2):38-44
28. Ghezzi A, Amato MP, Makhani N, Shreiner T, Gärtner J, Tenembaum S. Pediatric multiple sclerosis: Conventional first-line treatment and general management. Neurology. 2016;87(9):S97–102.
29. Tenembaum SN, Segura MJ. Interferon beta-1a treatment in childhood and juvenile-onset multiple sclerosis. Neurology . 2006;(5): 11–4. doi:10.1212/01.wnl.0000231137.24467.aa
30. Devonshire V, Lapierre Y, Macdonell R, Ramo-Tello C, Patti F, Fontoura P, et al. The Global Adherence Project (GAP): A multicenter observational study on adherence to disease-modifying therapies in patients with relapsing-remitting multiple sclerosis. Eur J Neurol. 2011;18(1):69–77.
31. Thannhauser JE, Mah JK, Metz LM. Adherence of Adolescents to Multiple Sclerosis Disease-Modifying Therapy. Pediatr Neurol . 2009;41(2):119
32. Ebers CG,Bulman ED,Sadovnick DA,et al . A population -based study of multiple sclerosis in twins. The New England Journal of Medicine. 1986; 315 (26):1638-1642
33. Kürtüncü M,Eraksoy M. Multiple Sclerosis: Could it be an epigenetic disease ? . Archives of Neuropsychiatry. 2008; 45: 15-20.