Early onset multiple sclerosis and the effect of disease onset age on neurological disability in multiple sclerosis

Multiple sclerosis (MS) is an autoimmune chronic inflammatory, and demyelinating disease of the central nervous system. The typical first neurological symptom for MS usually occurs between the ages of 20–40 years [1]. The age onset of the disease is defined as early onset MS (EOMS) or pediatric MS, if younger than 18 years of age; adult onset MS (AOMS) occurs between 18 and 49 years of age and late onset MS occurs at > 50 years of age [2]. EOMS patients are divided into onset at childhood (2–10 years of age) and adolescence (10–18 years of age). While there is a relative increase in males in the childhood age group (1.5–2:1), the female/male ratio increases to 2–4:1 in adolescence [3]. EOMS accounts for approximately 2–10 % of all MS patients [4]. While the majority of EOMS patients are affected during adolescence, less than 1 % of all MS patients are younger than 10 years of age [5]. Relapsing-remitting MS is the most common form in all MS patients, and its occurrence from 85 % in AOMS patients can increase up to 98 % in EOMS patients [6]. The other form, primary progressive MS, accounts for less than 2 % of patients with EOMS [7]. Although the pathophysiology of MS is still unclear, environmental factors such as exposure to cigarette smoke, Epstein-Barr virus infection, low vitamin D levels and genetic factors such as HLA-DRB1–15 are among the probable causes [8], [9], [10].

EOMS patients, like AOMS patients, may present with a wide variety of symptoms, including optic neuritis, sensory, brainstem-cerebellar, and motor symptoms [11]. However, EOMS patients have a more aggressive onset, more polyfocal onset, and higher recurrence in the early stages of the disease, when compared with AOMS patients [12], [13]. The course of the disease is slower in EOMS patients, and it takes > 10 years to reach the secondary progressive phase in AOMS patients [14]. Although the time from onset to disability is longer in EOMS patients than in AOMS patients, increased disability stages are reached at an earlier age [11].

Expanded disability status scale (EDSS), which is a scale that is scored between 0 and 10 points, was used to assess the degree of neurological disability. EDSS scores > 6, indicative of irreversible disability, indicate the ability to walk no more than 100 m with only unilateral support and without rest ([15]. The aim of this study was therefore to evaluate the age of onset as a risk factor for reaching an EDSS score of six, and to compare the demographic, clinical and magnetic resonance imaging (MRI) features of patients with EOMS and AOMS.

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