Epidemiological and clinical features of pediatric-onset multiple sclerosis: A population-based study in Isfahan, Iran, between 1997-2020

Masoud Etemadifar; Amir Parsa Abhari; Ghasem Yadegarfar; Mehri Salari; Mohammadreza Ghazavi; Milad Rayani; Hosein Nouri; Parisa Kargaran; Shahrbanoo Mazaheri; Homa Saadat

doi:10.18502/cjn.v20i4.8348

Masoud Etemadifar Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Amir Parsa Abhari Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
Ghasem Yadegarfar Department of Statistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
Mehri Salari Department of Neurological Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Mohammadreza Ghazavi Department of Pediatric Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Milad Rayani Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
Hosein Nouri Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
Parisa Kargaran Department of Cardiovascular Medicine, Center for Regenerative Medicine, Mayo Clinic, Rochester, Minnesota, USA
Shahrbanoo Mazaheri Department of Diseases and Transplantation, Isfahan University of Medical Sciences, Isfahan, Iran
Homa Saadat Department of Diseases and Transplantation, Isfahan University of Medical Sciences, Isfahan, Iran

DOI: https://doi.org/10.18502/cjn.v20i4.8348

Keywords: Multiple Sclerosis; Pediatric; Epidemiology; Prevalence; Incidence

Abstract

Background: Pediatric-onset multiple sclerosis (POMS) is an autoimmune demyelinating disorder of the central nervous system (CNS), affecting individuals younger than 18 years of age. We sought to characterize the epidemiological and clinical features of patients with POMS in Isfahan, Iran, from April
1997 to March 2020.

Methods: The medical records of patients with POMS in the databases of Isfahan Department of Public Health and Isfahan Multiple Sclerosis Society (IMSS) were retrospectively reviewed. The 2006 and 2016 Isfahan Province population censuses were used as reference values for assessing the temporal trend of POMS.

Results: From April 1997 to March 2020, 509 individuals under18 years of age were diagnosed with POMS in Isfahan. 404 of these patients (79.4%) were girls, and 105 patients (20.6%) were boys (a female to male ratio of 3.85:1). Most of the patients (83%) were monosymptomatic at onset, with optic neuritis and brainstem-cerebellar disorders being the most frequent initial presentations. Mean ± standard deviation (SD) of age at disease diagnosis was 15.8 ± 2.5 years (ranging from 3 to 18, mode = 18).From April 2019 to March 2020, the crude prevalence and the crude incidence rate of the POMS were 5.42 per 100000 and 1.86 per 100000, respectively. Poisson regression analysis revealed a 3.4% increase in the incidence rate of POMS from April 1997 to March 2020 [relative rate:1.034, 95% confidence interval (CI): 1.021-1.048].

Conclusion: The female to male ratio in our cohort was significantly higher than any other studies conducted previously. The high female to male ratio and increasing incidence of the disease suggest increasing regionalization of care.