title: Clinical features and viral serologies in children with multiple sclerosis: a multinational observational study.
abstract: BACKGROUND
  The full spectrum of clinical manifestations and outcome, and the potential importance of regional or demographic features or viral triggers in paediatric multiple sclerosis (MS), has yet to be fully characterised. Our aim was to determine some of these characteristics in children with MS.
  
  
  METHODS
  137 children with MS and 96 control participants matched by age and geographical region were recruited in a multinational study. They underwent structured clinical-demographic interviews, review of academic performance, physical examination, disability assessment (MS patients only), and standardised assays for IgG antibodies directed against Epstein-Barr virus, cytomegalovirus, parvovirus B19, varicella zoster virus, and herpes simplex virus.
  
  
  RESULTS
  MS was relapsing-remitting at diagnosis in 136 (99%) children. The first MS attack resembled acute disseminated encephalomyelitis (ADEM) in 22 (16%) of the children, most under 10 years old (mean age 7.4 [SD 4.2] years). Children with ADEM-like presentations were significantly younger than were children with polyfocal (11.2 [4.5] years; p<0.0001) or monofocal (12.0 [3.8] years; p=0.0005) presentations. Permanent physical disability (EDSS>or=4.0) developed within 5 years in 15 (13%) of the 120 children for whom EDSS score was available. 23 (17%) had impaired academic performance, which was associated with increasing disease duration (p=0.02). Over 108 (86%) of the children with MS, irrespective of geographical residence, were seropositive for remote EBV infection, compared with only 61 (64%) of matched controls (p=0.025, adjusted for multiple comparisons). Children with MS did not differ from controls in seroprevalence of the other childhood viruses studied, nor with respect to month of birth, sibling number, sibling rank, or exposure to young siblings.
  
  
  CONCLUSIONS
  Paediatric MS is a relapsing-remitting disease, with presenting features that vary by age at onset. MS in children might be associated with exposure to EBV, suggesting a possible role for EBV in MS pathobiology.
authors: Division of Neurology, The Hospital for Sick Children, University of Toronto, ON, Canada. brenda.banwell@sickkids.ca
authors: Brenda
authors: B
authors: Banwell
authors: Lauren
authors: L
authors: Krupp
authors: Julia
authors: J
authors: Kennedy
authors: Raymond
authors: R
authors: Tellier
authors: Silvia
authors: S
authors: Tenembaum
authors: Jayne
authors: J
authors: Ness
authors: Anita
authors: A
authors: Belman
authors: Alexei
authors: A
authors: Boiko
authors: Olga
authors: O
authors: Bykova
authors: Emmanuelle
authors: E
authors: Waubant
authors: Jean K
authors: JK
authors: Mah
authors: Cristina
authors: C
authors: Stoian
authors: Marcelo
authors: M
authors: Kremenchutzky
authors: Maria Rita
authors: MR
authors: Bardini
authors: Martino
authors: M
authors: Ruggieri
authors: Mary
authors: M
authors: Rensel
authors: Jin
authors: J
authors: Hahn
authors: Bianca
authors: B
authors: Weinstock-Guttman
authors: E Ann
authors: EA
authors: Yeh
authors: Kevin
authors: K
authors: Farrell
authors: Mark
authors: M
authors: Freedman
authors: Matti
authors: M
authors: Iivanainen
authors: Meri
authors: M
authors: Sevon
authors: Virender
authors: V
authors: Bhan
authors: Marie-Emmanuelle
authors: ME
authors: Dilenge
authors: Derek
authors: D
authors: Stephens
authors: Amit
authors: A
authors: Bar-Or
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D000914:Antibodies, Viral / Q000097:blood*; D000956:Antigens, Viral / Q000276:immunology; D016022:Case-Control Studies; D002648:Child; D003710:Demography; D004185:Disability Evaluation; D004467:Economics; D005260:Female; D004854:Herpesvirus 4, Human / Q000276:immunology; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D009103:Multiple Sclerosis / Q000453:epidemiology / Q000503:physiopathology / Q000821:virology; D019370:Observation; D010372:Pediatrics; D016036:Seroepidemiologic Studies; D012720:Severity of Illness Index; D018139:Simplexvirus / Q000276:immunology
chemical_list: D000914:Antibodies, Viral; D000956:Antigens, Viral