title: Prognostic indicators of secondary progression in a paediatric-onset multiple sclerosis cohort in Kuwait.
abstract: The frequency of paediatric-onset multiple sclerosis (POMS) and the precise risk of secondary progression of disease are largely unknown in the Middle East. This cross-sectional cohort study assessed the risk and examined prognostic factors for time to onset of secondary progressive multiple sclerosis (SPMS) in a cohort of POMS patients.
  
  
  
  The Kuwait National MS Registry database was used to identify a cohort of POMS cases (diagnosed at age <18 years) from 1994 to 2013. Data were abstracted from patients' records. A Cox proportional hazards model was used to evaluate the prognostic significance of the variables considered.
  
  
  
  Of 808 multiple sclerosis (MS) patients, 127 (15.7%) were POMS cases. The median age (years) at disease onset was 16.0 (range 6.5-17.9). Of 127 POMS cases, 20 (15.8%) developed SPMS. A multivariable Cox proportional hazards model showed that at MS onset, brainstem involvement (adjusted hazard ratio 5.71; 95% confidence interval 1.53-21.30; P=0.010), and POMS patient age at MS onset (adjusted hazard ratio 1.38; 95% confidence interval 1.01-1.88; P=0.042) were significantly associated with the increased risk of a secondary progressive disease course.
  
  
  
  This study showed that POMS patients with brainstem/cerebellar presentation and a relatively higher age at MS onset had disposition for SPMS and warrant an aggressive therapeutic approach.
authors.affiliation: Department of Community Medicine and Behavioural Sciences, University of Kuwait, Kuwait saeed.akhtar@hsc.edu.kw.
authors.forename: Saeed
authors.initials: S
authors.lastname: Akhtar
authors.affiliation: Division of Neurology, Amiri Hospital, Kuwait/ Neurology Clinic, Dasman Diabetes Institute, Kuwait.
authors.forename: Raed
authors.initials: R
authors.lastname: Alroughani
authors.affiliation: Department of Neurology, Ibn Sina Hospital, Kuwait/ Department of Neurology and Psychiatry, Minia University, Egypt.
authors.forename: Samar F
authors.initials: SF
authors.lastname: Ahmed
authors.affiliation: Department of Neurology, Ibn Sina Hospital, Kuwait/ Department of Medicine, University of Kuwait, Kuwait.
authors.forename: Jasem Y
authors.initials: JY
authors.lastname: Al-Hashel
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D001933:Brain Stem / Q000000981:diagnostic imaging; D002531:Cerebellum / Q000000981:diagnostic imaging; D002648:Child; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007730:Kuwait / Q000453:epidemiology; D008297:Male; D020528:Multiple Sclerosis, Chronic Progressive / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
keywords: Kuwait; Paediatric-onset multiple sclerosis; cross-sectional cohort study; hazard ratio; prognostic factors; secondary progression; survival analysis