Tunç Abdulkadir, Seferoğlu Meral, Sivaci Ali Özhan, Köktürk Mevrehan Dilber, Polat Ayşe Kristina
Sakarya University Faculty of Medicine, Department of Neurology, Sakarya, Turkey.
University Of Health Sciences Bursa Yuksek Ihtisas Training And Research Hospital, Department of Neurology, Bursa, Turkey.
Mult Scler Relat Disord. 2025 Jan;93:106184. doi: 10.1016/j.msard.2024.106184. Epub 2024 Nov 22.
This study aimed to conduct a unified analysis comparing the clinical characteristics, disease progression, and treatment responses of pediatric-onset multiple sclerosis (POMS), adult-onset multiple sclerosis (AOMS), and late-onset multiple sclerosis (LOMS) patients.
Utilizing a retrospective cohort design, we analyzed the records of 269 patients from MS clinics and categorized them into the POMS (<18 years), AOMS (≥18 and <50 years), and LOMS (≥50 years) groups based on age at diagnosis. Data collection focused on demographics, clinical manifestations, disability scores, MRI findings, and treatment outcomes.
Our findings indicate that while there was a consistent female majority across all groups, distinct smoking habits and differences in disease onset and progression were observed. Disease onset showed substantial differences, with 38.5 % of LOMS patients having a progressive onset. Disability scores increased from the POMS to the LOMS, with a baseline mean EDSS score of 1.81, and the LOMS group had the highest current EDSS score of 3.33. The ARR was greater in the LOMS group. Brainstem and spinal cord lesions were more common in patients with POMS and LOMS, but the difference was not statistically significant. Among those tested, 89.6 % showed OCB positivity. There was a notable shift toward second-line therapies, especially among LOMS patients, with 49.1 % achieving disease control with their initial DMT. Disease control was achieved by 59.7 % of the POMS patients, 47 % of the AOMS patients, and 38.5 % of the LOMS patients. Progression independent of relapse activity (PIRA) was observed in 19.7 % of patients, with higher second-line treatment requirements and higher EDSS scores in the PIRA group.
Significant differences in clinical profiles and treatment responses among POMS, AOMS, and LOMS patients underscore the necessity for age-specific management strategies for MS, emphasizing the unique challenges faced by LOMS patients.
本研究旨在对儿童期起病的多发性硬化症（POMS）、成人期起病的多发性硬化症（AOMS）和晚发性多发性硬化症（LOMS）患者的临床特征、疾病进展和治疗反应进行统一分析。
采用回顾性队列设计，我们分析了来自多发性硬化症诊所的269例患者的记录，并根据诊断时的年龄将他们分为POMS组（<18岁）、AOMS组（≥18岁且<50岁）和LOMS组（≥50岁）。数据收集集中在人口统计学、临床表现、残疾评分、MRI结果和治疗结果。
我们的研究结果表明，虽然所有组中女性均占多数，但观察到不同的吸烟习惯以及疾病起病和进展的差异。疾病起病存在显著差异，38.5%的LOMS患者起病呈进行性。残疾评分从POMS组到LOMS组逐渐升高，基线平均扩展残疾状态量表（EDSS）评分为1.81，LOMS组当前的EDSS评分最高，为3.33。LOMS组的年复发率（ARR）更高。脑干和脊髓病变在POMS和LOMS患者中更为常见，但差异无统计学意义。在接受检测的患者中，89.6%显示寡克隆带（OCB）阳性。二线治疗的使用有显著增加，尤其是在LOMS患者中，49.1%的患者通过初始疾病修正治疗（DMT）实现了疾病控制。POMS患者中有59.7%、AOMS患者中有47%、LOMS患者中有38.5%实现了疾病控制。19.7%的患者观察到与复发活动无关的疾病进展（PIRA），PIRA组对二线治疗的需求更高，EDSS评分也更高。
POMS、AOMS和LOMS患者在临床特征和治疗反应方面存在显著差异，这突出了针对多发性硬化症制定特定年龄管理策略的必要性，强调了LOMS患者面临的独特挑战。
