title: Pediatric-Onset Multiple Sclerosis Disease Progression in Kuwait: A Retrospective Analysis.
abstract: BACKGROUND
  Pediatric and adults patients share basic aspects of multiple sclerosis; however, pediatric patients may have distinctive clinical features and disease course.
  
  
  OBJECTIVE
  To compare the demographic and clinical characteristics between patients of pediatric-onset and adult-onset multiple sclerosis.
  
  
  METHODS
  Using the Kuwait National Multiple Sclerosis Registry , multiple sclerosis patients with disease onset at age ≤ 17 years (pediatric-onset multiple sclerosis) or >17 years (adult-adult multiple sclerosis) were identified. Several demographics and clinical characteristics were analyzed. Disability measures and time to reach secondary progressive multiple sclerosis were compared between the two cohorts using chi-square and Student t tests.
  
  
  RESULTS
  A total of 984 records of multiple sclerosis patients were assessed, of which 111 (11.3%) had disease onset at age ≤ 17 years. The female to male ratio did not differ between the two groups (P = 0.19). The mean age at onset of pediatric- and adult-onset multiple sclerosis was 14.9 and 27.68 years, respectively. Pediatric-onset multiple sclerosis patients were more likely to have brainstem/cerebellar (P < 0.03) and multifocal (P < 0.01) presentations at onset. The mean number of relapses did not differ between the two cohorts (3.4 ± 2.1 versus 3.05 ± 2.2; P = 0.14). The mean expanded disability status scale score at last visit was lower in the pediatric-onset cohort compared with the adult-onset cohort (2.38 ± 1.72 versus 3.02 ± 2.18; P = 0.003). The time to develop secondary progressive multiple sclerosis was longer in the pediatric-onset cohort (14.6 ± 4.6 years versus 11.0 ± 5.3 years; P < 0.04).
  
  
  CONCLUSIONS
  Pediatric-onset multiple sclerosis patients were more likely to have brainstem/cerebellar and multifocal symptoms at onset. Although the number of relapses was comparable to the adult-onset cohort, multiple sclerosis patients with pediatric-onset had lower expanded disability status scale scores and a longer time to reach secondary progressive course at last follow-up visits.
authors.affiliation: Division of Neurology, Amiri Hospital, Arabian Gulf Street, Sharq, Kuwait; Neurology Clinic, Dasman Diabetes Institute, Dasman, Kuwait. Electronic address: alroughani@gmail.com.
authors.forename: Raed
authors.initials: R
authors.lastname: Alroughani
authors.affiliation: Department of Neurology, Ibn Sina Hospital, Safat, Kuwait; Department of Neurology and Psychiatry, Minia University, Minia, Egypt.
authors.forename: Samar F
authors.initials: SF
authors.lastname: Ahmed
authors.affiliation: Department of Neurology, Ibn Sina Hospital, Safat, Kuwait; Department of Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait.
authors.forename: Jasem
authors.initials: J
authors.lastname: Al-Hashel
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D002648:Child; D018450:Disease Progression; D005260:Female; D006801:Humans; D007730:Kuwait / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000453:epidemiology*; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Kuwait; disability; multiple sclerosis; pediatric; progression