title: The course of early-onset multiple sclerosis in Iraqi children.
abstract: BACKGROUND
  Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system that is increasingly recognized worldwide in children and adolescents. The current study aimed at identifying the clinical characteristics of MS with onset under 18 years of age.
  
  
  METHODS
  This cross-sectional study was conducted in the Multiple Sclerosis Center archive system in Baghdad Teaching Hospital during the period from March 1 to May 15, 2008. The records of 1125 MS patients from 2000 to 2008 were reviewed. Among them 77 patients had the onset of MS under 18 years of age.
  
  
  RESULTS
  Two thirds of the patients were female (a female/male ratio of 1.6:1). The mean age of the patients at the onset of the disease was 14.95 ± 3.21 years, and the mean time between the first and second attacks was 3.06 ± 4.09 years. Seventy patients (90.9%) had an initial course of relapse remitting MS. Among them 9 (12.9%) progressed to secondary progressive MS after a mean duration of 9.87 ± 4.14 years. The remaining 7 patients had primary progressive MS associated with optic neuritis and brain stem lesion. Fifty-nine (76.6%) patients had monofocal signs and 18 (23.4%) had polyfocal signs. The mean extended disability status scale score was 4.15 ± 2.17 and the mean progression index was 1.44 ± 2.31. There was a strong inversed correlation between the progression index and interval between the first and second attacks (P=0.0001).
  
  
  CONCLUSIONS
  The results of the present study show that the course of MS in Iraqi children and adolescents is more aggressive than in children from other countries. This finding needs to be evaluated by further studies.
authors.affiliation: Department of Medicine/Neurology, College of Medicine, Al-Nahrain University, Baghdad, Iraq.
authors.forename: Hasan A
authors.initials: HA
authors.lastname: Al-Hamadani
authors.forename: Atheer S
authors.initials: AS
authors.lastname: Abdalla
authors.forename: Atheer J
authors.initials: AJ
authors.lastname: Al-Saffar
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000465:Algorithms; D001933:Brain Stem / Q000473:pathology; D002648:Child; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007493:Iraq / Q000453:epidemiology; D008297:Male; D009103:Multiple Sclerosis / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology; D009902:Optic Neuritis / Q000209:etiology; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index