Early effective treatment may protect from cognitive decline in paediatric multiple sclerosis
Cognitive impairment (CI) is a critical feature for patients with childhood or juvenile multiple sclerosis (MS). To promote the understanding of CI and to address the impact of different pharmacological treatment strategies on cognitive performance in this patient group. A cohort of 19 patients with...
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| Published in: | European journal of paediatric neurology Vol. 23; no. 6; pp. 783 - 791 |
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| Main Authors: | , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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England
Elsevier Ltd
01.11.2019
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| ISSN: | 1090-3798, 1532-2130, 1532-2130 |
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| Abstract | Cognitive impairment (CI) is a critical feature for patients with childhood or juvenile multiple sclerosis (MS).
To promote the understanding of CI and to address the impact of different pharmacological treatment strategies on cognitive performance in this patient group.
A cohort of 19 patients with therapy-naïve or ß-Interferon-treated juvenile MS completed a comprehensive neuropsychological assessment at initial presentation (baseline) and on average 2.5 years later (follow-up). The assessments were complemented with a neuropaediatric examination and conventional cerebral magnetic resonance imaging (MRI).
9 patients (47%) were impaired in at least one test at baseline (z-score <-1.645 compared with age-adjusted normative data), with the highest impairment frequency in the domains processing speed and attention & executive functions. At follow-up a higher impairment frequency was prominent in those patients whose therapy had not been escalated (N = 13, 69% impaired in at least one test), while cognition was preserved or ameliorated in patients whose treatment had been escalated to highly effective drugs (N = 6, 0% impaired) during the observational period. These group differences at follow-up were not attributable to differences regarding demographics, MRI metrics or cognitive performance at baseline.
Our findings confirm that paediatric MS is associated with considerable CI already in early disease stages. Early administration of highly effective treatment may protect from cognitive decline or alleviate CI in juvenile MS, but larger controlled trials are warranted to confirm these preliminary results.
•Paediatric patients with MS underwent longitudinal cognitive assessments.•Certain patients were escalated to second-line disease modifying drugs.•These patients showed significantly less cognitive impairment at follow-up.•Highly effective disease modifying drugs may alleviate cognitive impairment.•But larger, placebo-controlled studies are warranted. |
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| AbstractList | Cognitive impairment (CI) is a critical feature for patients with childhood or juvenile multiple sclerosis (MS).BACKGROUNDCognitive impairment (CI) is a critical feature for patients with childhood or juvenile multiple sclerosis (MS).To promote the understanding of CI and to address the impact of different pharmacological treatment strategies on cognitive performance in this patient group.OBJECTIVETo promote the understanding of CI and to address the impact of different pharmacological treatment strategies on cognitive performance in this patient group.A cohort of 19 patients with therapy-naïve or ß-Interferon-treated juvenile MS completed a comprehensive neuropsychological assessment at initial presentation (baseline) and on average 2.5 years later (follow-up). The assessments were complemented with a neuropaediatric examination and conventional cerebral magnetic resonance imaging (MRI).METHODSA cohort of 19 patients with therapy-naïve or ß-Interferon-treated juvenile MS completed a comprehensive neuropsychological assessment at initial presentation (baseline) and on average 2.5 years later (follow-up). The assessments were complemented with a neuropaediatric examination and conventional cerebral magnetic resonance imaging (MRI).9 patients (47%) were impaired in at least one test at baseline (z-score <-1.645 compared with age-adjusted normative data), with the highest impairment frequency in the domains processing speed and attention & executive functions. At follow-up a higher impairment frequency was prominent in those patients whose therapy had not been escalated (N = 13, 69% impaired in at least one test), while cognition was preserved or ameliorated in patients whose treatment had been escalated to highly effective drugs (N = 6, 0% impaired) during the observational period. These group differences at follow-up were not attributable to differences regarding demographics, MRI metrics or cognitive performance at baseline.RESULTS9 patients (47%) were impaired in at least one test at baseline (z-score <-1.645 compared with age-adjusted normative data), with the highest impairment frequency in the domains processing speed and attention & executive functions. At follow-up a higher impairment frequency was prominent in those patients whose therapy had not been escalated (N = 13, 69% impaired in at least one test), while cognition was preserved or ameliorated in patients whose treatment had been escalated to highly effective drugs (N = 6, 0% impaired) during the observational period. These group differences at follow-up were not attributable to differences regarding demographics, MRI metrics or cognitive performance at baseline.Our findings confirm that paediatric MS is associated with considerable CI already in early disease stages. Early administration of highly effective treatment may protect from cognitive decline or alleviate CI in juvenile MS, but larger controlled trials are warranted to confirm these preliminary results.CONCLUSIONOur findings confirm that paediatric MS is associated with considerable CI already in early disease stages. Early administration of highly effective treatment may protect from cognitive decline or alleviate CI in juvenile MS, but larger controlled trials are warranted to confirm these preliminary results. Cognitive impairment (CI) is a critical feature for patients with childhood or juvenile multiple sclerosis (MS). To promote the understanding of CI and to address the impact of different pharmacological treatment strategies on cognitive performance in this patient group. A cohort of 19 patients with therapy-naïve or ß-Interferon-treated juvenile MS completed a comprehensive neuropsychological assessment at initial presentation (baseline) and on average 2.5 years later (follow-up). The assessments were complemented with a neuropaediatric examination and conventional cerebral magnetic resonance imaging (MRI). 9 patients (47%) were impaired in at least one test at baseline (z-score <-1.645 compared with age-adjusted normative data), with the highest impairment frequency in the domains processing speed and attention & executive functions. At follow-up a higher impairment frequency was prominent in those patients whose therapy had not been escalated (N = 13, 69% impaired in at least one test), while cognition was preserved or ameliorated in patients whose treatment had been escalated to highly effective drugs (N = 6, 0% impaired) during the observational period. These group differences at follow-up were not attributable to differences regarding demographics, MRI metrics or cognitive performance at baseline. Our findings confirm that paediatric MS is associated with considerable CI already in early disease stages. Early administration of highly effective treatment may protect from cognitive decline or alleviate CI in juvenile MS, but larger controlled trials are warranted to confirm these preliminary results. Cognitive impairment (CI) is a critical feature for patients with childhood or juvenile multiple sclerosis (MS). To promote the understanding of CI and to address the impact of different pharmacological treatment strategies on cognitive performance in this patient group. A cohort of 19 patients with therapy-naïve or ß-Interferon-treated juvenile MS completed a comprehensive neuropsychological assessment at initial presentation (baseline) and on average 2.5 years later (follow-up). The assessments were complemented with a neuropaediatric examination and conventional cerebral magnetic resonance imaging (MRI). 9 patients (47%) were impaired in at least one test at baseline (z-score <-1.645 compared with age-adjusted normative data), with the highest impairment frequency in the domains processing speed and attention & executive functions. At follow-up a higher impairment frequency was prominent in those patients whose therapy had not been escalated (N = 13, 69% impaired in at least one test), while cognition was preserved or ameliorated in patients whose treatment had been escalated to highly effective drugs (N = 6, 0% impaired) during the observational period. These group differences at follow-up were not attributable to differences regarding demographics, MRI metrics or cognitive performance at baseline. Our findings confirm that paediatric MS is associated with considerable CI already in early disease stages. Early administration of highly effective treatment may protect from cognitive decline or alleviate CI in juvenile MS, but larger controlled trials are warranted to confirm these preliminary results. •Paediatric patients with MS underwent longitudinal cognitive assessments.•Certain patients were escalated to second-line disease modifying drugs.•These patients showed significantly less cognitive impairment at follow-up.•Highly effective disease modifying drugs may alleviate cognitive impairment.•But larger, placebo-controlled studies are warranted. |
| Author | Krämer, J. Riepl, E. Omran, H. Polzer, P. Elpers, C. Landmeyer, N.C. Wiendl, H. Lohmann, H. Meuth, S.G. Johnen, A. Göbel, K. |
| Author_xml | – sequence: 1 givenname: A. surname: Johnen fullname: Johnen, A. email: andreas.johnen@ukmuenster.de organization: University of Münster, Department of Neurology with Institute of Translational Neurology, Germany – sequence: 2 givenname: C. surname: Elpers fullname: Elpers, C. organization: University of Münster, University Children's Hospital Münster, General Pediatrics – Neuropediatric Department, Germany – sequence: 3 givenname: E. surname: Riepl fullname: Riepl, E. organization: University of Münster, Department of Neurology with Institute of Translational Neurology, Germany – sequence: 4 givenname: N.C. surname: Landmeyer fullname: Landmeyer, N.C. organization: University of Münster, Department of Neurology with Institute of Translational Neurology, Germany – sequence: 5 givenname: J. surname: Krämer fullname: Krämer, J. organization: University of Münster, Department of Neurology with Institute of Translational Neurology, Germany – sequence: 6 givenname: P. surname: Polzer fullname: Polzer, P. organization: University of Münster, Institute of Clinical Radiology, Germany – sequence: 7 givenname: H. surname: Lohmann fullname: Lohmann, H. organization: Herz-Jesu-Hospital, Münster-Hiltrup, Germany – sequence: 8 givenname: H. surname: Omran fullname: Omran, H. organization: University of Münster, University Children's Hospital Münster, General Pediatrics – Neuropediatric Department, Germany – sequence: 9 givenname: H. surname: Wiendl fullname: Wiendl, H. organization: University of Münster, Department of Neurology with Institute of Translational Neurology, Germany – sequence: 10 givenname: K. surname: Göbel fullname: Göbel, K. organization: University of Münster, Department of Neurology with Institute of Translational Neurology, Germany – sequence: 11 givenname: S.G. surname: Meuth fullname: Meuth, S.G. organization: University of Münster, Department of Neurology with Institute of Translational Neurology, Germany |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31540711$$D View this record in MEDLINE/PubMed |
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| Copyright | 2019 European Paediatric Neurology Society Copyright © 2019 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved. |
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| Keywords | Juvenile multiple sclerosis Cognition Treatment Neuropsychology Paediatric multiple sclerosis Disease-modifying drugs |
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To promote the understanding of CI and to... Cognitive impairment (CI) is a critical feature for patients with childhood or juvenile multiple sclerosis (MS).BACKGROUNDCognitive impairment (CI) is a... |
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| Title | Early effective treatment may protect from cognitive decline in paediatric multiple sclerosis |
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