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Early effective treatment may protect from cognitive decline in paediatric multiple sclerosis

  • Author Footnotes
    1 A. Johnen and C. Elpers contributed equally to this article.
    A. Johnen
    Correspondence
    Corresponding author. University Hospital Münster, Department of Neurology with Institute of Translational Neurology, Albert-Schweitzer-Campus 1, 48149 Münster, Germany. Fax: +492518345313.
    Footnotes
    1 A. Johnen and C. Elpers contributed equally to this article.
    Affiliations
    University of Münster, Department of Neurology with Institute of Translational Neurology, Germany
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  • Author Footnotes
    1 A. Johnen and C. Elpers contributed equally to this article.
    C. Elpers
    Footnotes
    1 A. Johnen and C. Elpers contributed equally to this article.
    Affiliations
    University of Münster, University Children's Hospital Münster, General Pediatrics – Neuropediatric Department, Germany
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  • E. Riepl
    Affiliations
    University of Münster, Department of Neurology with Institute of Translational Neurology, Germany
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  • N.C. Landmeyer
    Affiliations
    University of Münster, Department of Neurology with Institute of Translational Neurology, Germany
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  • J. Krämer
    Affiliations
    University of Münster, Department of Neurology with Institute of Translational Neurology, Germany
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  • P. Polzer
    Affiliations
    University of Münster, Institute of Clinical Radiology, Germany
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  • H. Lohmann
    Affiliations
    Herz-Jesu-Hospital, Münster-Hiltrup, Germany
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  • H. Omran
    Affiliations
    University of Münster, University Children's Hospital Münster, General Pediatrics – Neuropediatric Department, Germany
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  • H. Wiendl
    Affiliations
    University of Münster, Department of Neurology with Institute of Translational Neurology, Germany
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  • Author Footnotes
    2 K. Göbel and S.G. Meuth contributed equally to this article.
    K. Göbel
    Footnotes
    2 K. Göbel and S.G. Meuth contributed equally to this article.
    Affiliations
    University of Münster, Department of Neurology with Institute of Translational Neurology, Germany
    Search for articles by this author
  • Author Footnotes
    2 K. Göbel and S.G. Meuth contributed equally to this article.
    S.G. Meuth
    Footnotes
    2 K. Göbel and S.G. Meuth contributed equally to this article.
    Affiliations
    University of Münster, Department of Neurology with Institute of Translational Neurology, Germany
    Search for articles by this author
  • Author Footnotes
    1 A. Johnen and C. Elpers contributed equally to this article.
    2 K. Göbel and S.G. Meuth contributed equally to this article.
Published:September 05, 2019DOI:https://doi.org/10.1016/j.ejpn.2019.08.007

      Highlights

      • Paediatric patients with MS underwent longitudinal cognitive assessments.
      • Certain patients were escalated to second-line disease modifying drugs.
      • These patients showed significantly less cognitive impairment at follow-up.
      • Highly effective disease modifying drugs may alleviate cognitive impairment.
      • But larger, placebo-controlled studies are warranted.

      Abstract

      Background

      Cognitive impairment (CI) is a critical feature for patients with childhood or juvenile multiple sclerosis (MS).

      Objective

      To promote the understanding of CI and to address the impact of different pharmacological treatment strategies on cognitive performance in this patient group.

      Methods

      A cohort of 19 patients with therapy-naïve or ß-Interferon-treated juvenile MS completed a comprehensive neuropsychological assessment at initial presentation (baseline) and on average 2.5 years later (follow-up). The assessments were complemented with a neuropaediatric examination and conventional cerebral magnetic resonance imaging (MRI).

      Results

      9 patients (47%) were impaired in at least one test at baseline (z-score <-1.645 compared with age-adjusted normative data), with the highest impairment frequency in the domains processing speed and attention & executive functions. At follow-up a higher impairment frequency was prominent in those patients whose therapy had not been escalated (N = 13, 69% impaired in at least one test), while cognition was preserved or ameliorated in patients whose treatment had been escalated to highly effective drugs (N = 6, 0% impaired) during the observational period. These group differences at follow-up were not attributable to differences regarding demographics, MRI metrics or cognitive performance at baseline.

      Conclusion

      Our findings confirm that paediatric MS is associated with considerable CI already in early disease stages. Early administration of highly effective treatment may protect from cognitive decline or alleviate CI in juvenile MS, but larger controlled trials are warranted to confirm these preliminary results.

      Keywords

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