title: Unfavorable outcome of pediatric onset multiple sclerosis: Follow-up in the pediatric and adult neurology departments of one referral center, in Turkey.
abstract: BACKGROUND
  The prevalence of MS starting under 18 years of age ranges between 2-10% of the total MS population.
  
  
  OBJECTIVE
  We aimed to examine the clinical and long term follow-up data of pediatric-onset cases in our institutional MS database.
  
  
  METHODS
  We evaluated the clinical data from the MS database of the Departments of Neurology and Pediatric Neurology of Hacettepe University Hospital.
  
  
  RESULTS
  The clinical features of 74 patients who had experienced the first attack before age 18 years comprised 3.9% of our MS population. Median age at onset was 15 (3, 5-17, IQR=3.63) years, and female: male ratio was 2.4. The most frequent symptom at onset was brainstem/cerebellar dysfunction (32.4%). Seventy two patients (97.3%) initially had relapsing remitting course and in the follow-up, 17 (23%) of them developed secondary progressive (SP) course. The median interval to develop SPMS course was 10 (5-21, IQR=8) years. At the last visit, median disease duration was 6.67 (0.83-25, IQR=9.06) years, 41 (55.4%) of them had EDSS of ≥4.
  
  
  CONCLUSIONS
  These findings illustrate the profile of our pediatric MS patients: almost all are relapsing-remitting initially; about one fourth become secondarily progressive in 10 years, and about half acquire disability EDSS ≥4 in mean 8 years.
authors.affiliation: Department of Neurology, Baskent University Faculty of Medicine, Mareşal Fevzi Çakmak Cad. 10.sok No: 45, Bahçelievler, Ankara, Turkey. Electronic address: edaderle@hotmail.com.
authors.forename: Eda
authors.initials: E
authors.lastname: Derle
authors.affiliation: Department of Neurology, Hacettepe University Faculty of Medicine, Hacettepe Üniversitesi Tıp Fakültesi, 06100 Sıhhiye Ankara, Turkey.
authors.forename: Aslı Tuncer
authors.initials: AT
authors.lastname: Kurne
authors.affiliation: Division of Pediatric Neurology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Hacettepe Üniversitesi Tıp Fakültesi, 06100 Sıhhiye Ankara, Turkey.
authors.forename: Bahadır
authors.initials: B
authors.lastname: Konuşkan
authors.affiliation: Department of Neurology, Hacettepe University Faculty of Medicine, Hacettepe Üniversitesi Tıp Fakültesi, 06100 Sıhhiye Ankara, Turkey.
authors.forename: Rana
authors.initials: R
authors.lastname: Karabudak
authors.affiliation: Division of Pediatric Neurology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Hacettepe Üniversitesi Tıp Fakültesi, 06100 Sıhhiye Ankara, Turkey.
authors.forename: Banu
authors.initials: B
authors.lastname: Anlar
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D002648:Child; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D012017:Referral and Consultation; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult
keywords: Childhood; Demographic feature; Demyelination; Longterm; Multiple sclerosis