Monday, December 28, 2015

Cognitive dysfunction in pediatric multiple sclerosis

Cardoso M, Olmo NR, Fragoso YD. Systematic Review of Cognitive Dysfunction in
Pediatric and Juvenile Multiple Sclerosis. Pediatr Neurol. 2015 Oct;53(4):287-92.



Cognitive dysfunction is a common finding in individuals with multiple sclerosis at all ages. Cognitive impairment may drastically affect the life of younger patients with multiple sclerosis who are still undergoing education and schooling.


We carried out a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations to assess the published data on multiple sclerosis and cognition in pediatric or juvenile patients. Only articles presenting original data on patients with multiple sclerosis diagnosed before age 18 years of age were included.


Thirty-two articles fulfilled the inclusion criteria for this systematic review. The conclusion from all articles was that cognitive dysfunction in multiple sclerosis starting before the age of 18 years is both significant and disruptive and must be routinely assessed. However, assessment methods were heterogeneous and often very expensive to perform, whereas proposals for treatment were virtually absent in the literature.


Cognitive dysfunction can be a significant symptom of multiple sclerosis of early onset, but its impact and management needs to be better assessed. A task force should be created to study and manage cognitive dysfunction in pediatric and juvenile multiple sclerosis.

Courtesy of:

Amato MP, Goretti B, Ghezzi A, Hakiki B, Niccolai C, Lori S, Moiola L,
Falautano M, Viterbo RG, Patti F, Cilia S, Pozzilli C, Bianchi V, Roscio M,
Martinelli V, Comi G, Portaccio E, Trojano M; MS Study Group of the Italian
Neurological Society. Neuropsychological features in childhood and juvenile
multiple sclerosis: five-year follow-up. Neurology. 2014 Oct 14;83(16):1432-8.



The aim of the study was to perform a third cognitive assessment in our pediatric-onset multiple sclerosis (MS) patient cohort and determine predictors of the individual cognitive outcome.


After 4.7 ± 0.7 years from baseline evaluation, 48 of 63 patients in the original cohort were reassessed on an extensive neuropsychological battery and compared with 46 healthy controls. Two alternate versions of the tests were used at different assessment points. Cognitive impairment was defined as the failure of ≥3 tests; individual change in the cognitive impairment index was measured.


At year 5, 38% of the subjects with MS fulfilled our criterion for impairment. Between years 2 and 5, regarding individual cognitive impairment index change, 66.7% of the patients improved. However, comparing baseline and 5-year testing (when the same versions of the tests were used), cognitive impairment index deterioration was observed in 56% of the patients, improvement in 25%, and stability in 18.8%. A deteriorating performance was related to male sex, younger age and age at MS onset, and lower education. None of these variables, however, was retained in the multivariate analysis.


Cognitive outcome in pediatric-onset MS can be heterogeneous. Progression of cognitive problems in a few subjects and potential for compensation and improvement in others call for systematic cognitive screening in this population and development of effective treatment strategies.

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