Background

The pathogenesis of multiple sclerosis (MS) involves immune-mediated mechanisms, and disease-modifying therapies (DMTs) administered in MS have immunomodulatory effects. The concern about MS patients' susceptibility to coronavirus disease 2019 (COVID-19) has prompted several studies based on clinical observations and questionnaires. Information about COVID-19 in pediatric-onset multiple sclerosis (POMS) is scarce. The objective of this study was to collect information on the experience of POMS patients with COVID-19 during the pandemic.

Methods

This cross-sectional study was conducted with POMS patients diagnosed at Hacettepe University Pediatric Neurology Department and under 23 years of age between October 1 and December 31, 2021. Those who experienced COVID-19 or had a history of contact and were found seropositive for COVID-19 were evaluated for the severity of COVID-19, disability, treatment status, and comorbidities.

Results

Among the 101 POMS patients, 13 reported having had COVID-19 and five were exposed and seropositive but clinically asymptomatic. Of these 18 patients, 14 were ≤18 years of age at the time of the study. All 13 patients (72%) reported mild symptoms without hospitalization or respiratory support. Four of 18 had a neurological disability (Expanded Disability Status Scale [EDSS] scores ranging between 1 and 7.5), while the remaining had a score of 0. The outcome of COVID-19 was not affected by DMTs, neurological disabilities, and comorbidities.

Conclusions

In this single-center POMS series, the small subgroup of patients who had contacted the SARS-CoV-2 virus or developed COVID-19 had reported no or mild symptoms. This may be partly related to the infrequent use of rituximab in this group. Our results corroborate those in adult-onset MS where no increased risk is reported for patients whose EDSS scores are <6 and who are not on B cell–depleting DMTs. Although less frequently than in adult MS, immunosuppressive DMTs may be needed in POMS; therefore, the importance of appropriate vaccination is to be underlined.

中文翻译：

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小儿发病多发性硬化症患者 COVID-19 的结果

背景

多发性硬化症 (MS) 的发病机制涉及免疫介导的机制，而在 MS 中使用的疾病缓解疗法 (DMT) 具有免疫调节作用。对 MS 患者对 2019 年冠状病毒病 (COVID-19) 易感性的担忧促使了多项基于临床观察和问卷调查的研究。关于小儿发病多发性硬化症 (POMS) 中 COVID-19 的信息很少。本研究的目的是收集有关 POMS 患者在大流行期间 COVID-19 的经历的信息。

方法

这项横断面研究是针对 2021 年 10 月 1 日至 12 月 31 日期间在 Hacettepe 大学儿科神经病学系诊断出的 23 岁以下的 POMS 患者进行的。那些经历过 COVID-19 或有接触史并被发现 COVID 血清反应阳性的患者-19 人接受了 COVID-19 的严重程度、残疾、治疗状况和合并症的评估。

结果

在 101 名 POMS 患者中，13 名报告患有 COVID-19，5 名已暴露且血清反应呈阳性但没有临床症状。在这 18 名患者中，有 14 名在研究时年龄≤18 岁。所有 13 名患者 (72%) 均报告症状轻微，无需住院或呼吸支持。18 人中有 4 人有神经残疾（扩展残疾状态量表 [EDSS] 得分在 1 到 7.5 之间），而其余的得分为 0。COVID-19 的结果不受 DMT、神经残疾和合并症的影响。

结论

在这个单中心 POMS 系列中，接触过 SARS-CoV-2 病毒或发展为 COVID-19 的一小部分患者报告没有症状或出现轻微症状。这可能部分与该组中不经常使用利妥昔单抗有关。我们的结果证实了那些成人发病的 MS，对于 EDSS 评分 <6 且未接受 B 细胞耗竭 DMT 的患者，未报告风险增加。尽管比成人 MS 频率低，但 POMS 可能需要免疫抑制 DMT；因此，应强调适当接种疫苗的重要性。