SYMPTOMS such as skin sensation disturbances, visual disturbances, and obesity may precede a diagnosis of paediatric multiple sclerosis (MS) by up to five years, recent research has shown. A population-based matched case-control study, conducted in Germany, systematically examined symptoms and diseases occurring within five years before a first diagnosis of MS in children and adolescents under 18 years. MS, typically an adult-onset condition, can affect younger individuals, with up to 10% of cases diagnosed in those under 18.
The study analysed nationwide German health insurance data from 2010 to 2020, including 1091 paediatric MS patients, 10,910 controls without MS, and 1068 controls with JIA. Logistic regression analyses identified nine conditions more frequently diagnosed in MS patients within five years of diagnosis compared to controls: obesity (adjusted odds ratio [AOR], 1.70; 95% CI, 1.42–2.02), disorders of refraction and accommodation (AOR, 1.26; 95% CI, 1.09–1.47), visual disturbances (AOR, 1.31; 95% CI, 1.10–1.55), gastritis and duodenitis (AOR, 1.35; 95% CI, 1.08–1.70), patella disorders (AOR, 1.47; 95% CI, 1.13–1.90), heartbeat abnormalities (AOR, 1.94; 95% CI, 1.27–2.96), flatulence (AOR, 1.43; 95% CI, 1.01–2.01), skin sensation disturbances (AOR, 12.93; 95% CI, 8.98–18.62), and dizziness/giddiness (AOR, 1.52; 95% CI, 1.22–1.89). In comparisons with JIA, four of these conditions, including skin sensation disturbances (AOR, 27.70; 95% CI, 6.52–117.64), remained significant.
The findings highlight the potential for diverse metabolic, ocular, musculoskeletal, gastrointestinal, and cardiovascular symptoms to serve as early indicators of paediatric MS. Early recognition of these prodromal features could improve clinical practice, particularly in guiding diagnostic workups and initiating earlier interventions. However, the results require validation in larger, prospective studies. Future research should explore the biological mechanisms underlying these associations and consider the potential benefits of targeted screening in at-risk populations.
Katrina Thornber, EMJ
Reference
Akmatov MK et al. Symptoms prior to diagnosis of multiple sclerosis in individuals younger than 18 years. JAMA Netw Open. 2024;7(12):e2452652.
