Cognitive impairment common in pediatric MS

NEW YORK (Reuters Health) - Low IQ scores and cognitive problems occur frequently in children and adolescents with multiple sclerosis, according to an Italian study reported in the May 13 issue of Neurology.

Approximately 5% of MS cases begin before age 18, note Dr. Maria Pia Amato, at the University of Florence, and her associates.

"The initial diagnosis of MS is more difficult in children than in adults," Dr. Amato told Reuters Health. Particularly before age 10,...

NEW YORK (Reuters Health) - Low IQ scores and cognitive problems occur frequently in children and adolescents with multiple sclerosis, according to an Italian study reported in the May 13 issue of Neurology.

Approximately 5% of MS cases begin before age 18, note Dr. Maria Pia Amato, at the University of Florence, and her associates.

"The initial diagnosis of MS is more difficult in children than in adults," Dr. Amato told Reuters Health. Particularly before age 10, "symptoms may resemble those of an acute encephalitis: fever, alteration of mental state and level of consciousness are associated with multifocal neurological deficits. Mechanical respiratory assistance may be required, and seizures and signs of basal ganglia involvement (rare in adults) can be observed."

In adolescents, she added, MS onset is more like that observed in young adults, with symptoms such as optic neuritis, paresis, brain stem and cerebellar symptoms and sensory disturbances, usually without any change in mental state.

In either case, there is concern that early onset could have greater impact on cognitive function if normal neurodevelopment is stunted.

In the researchers' study, 63 MS patients and 57 healthy controls younger than 18 years of age underwent a neuropsychological test battery. MS onset had occurred before age 10 in 15 subjects.

In the MS group, total IQ was 70-89 in 25.9%, and < 70 in 8.6%, versus 3.5% and 0%, respectively, in the control group. The only significant predictor of an IQ score < 70 was younger age at onset (odds ratio 0.7, p = 0.009).

Half of the MS patients failed at least two neuropsychological tests. Most affected were verbal and visuospatial memory, complex attention, and executive functions.

By interviewing parents, "we confirmed that the disease had a great functional impact and that, beyond the extent of physical disability, cognitive problems play a relevant role negatively affecting school, everyday, and social activities," the authors conclude.

"For comprehensive management of the patients, clinicians should always take into account MS-related cognitive and psychosocial problems and include their systematic evaluation in clinical practice," Dr. Amato emphasized. "Particularly in cases with a disease onset before 10 years of age, reduction of global intellectual faculties and language problems should be pursued and dealt with."

"I would like to highlight that treatment and support may help the subjects and the families to cope with their psychosocial difficulties," she added.

"Moreover, it is possible that brain plasticity, as well as reparative and compensatory abilities, may be more efficient in this age range. Therefore, early recognition of problems and intervention strategies, both rehabilitative and pharmacological, may lead to a better outcome."

Neurology 2008;70:1891-1897.