Younger children with MS have a distinct CSF inflammatory profile at disease onset

D. Chabas, J. Ness, A. Belman, E. A. Yeh, N. Kuntz, M. P. Gorman, J. B. Strober, I. De Kouchkovsky, C. McCulloch, T. Chitnis, M. Rodriguez, B. Weinstock-Guttman, L. B. Krupp, E. Waubant

Research output: Contribution to journalArticle

88 Citations (Scopus)

Abstract

BACKGROUND: The clinical and MRI presentation differs between earlier-and later-onset pediatric multiple sclerosis (MS), whereas the effect of age on the CSF inflammatory profile is unknown and may contribute to delayed diagnosis. OBJECTIVES: To compare the CSF cellular and immunoglobulin G (IgG) profiles between earlier-and later-onset pediatric MS. METHODS: We queried the databases of 6 pediatric MS centers for earlier-onset (onset <11 years) and later-onset (â‰111 and <18 years) patients with MS or clinically isolated syndrome who underwent CSF analysis within the first 3 months of presentation (observational study). We compared CSF white blood cell (WBC) differential count, IgG index, and IgG oligoclonal bands between age groups. RESULTS: We identified 40 earlier-onset (mean age at onset = 7.2 ± 2.7 years, 60% females) and 67 later-onset pediatric MS patients (15.1 ± 1.7 years, 63% females). Although WBC count tended to be higher in earlier-onset patients (median = 9/mm [0-343] vs 6 [0-140], p = 0.15), they had a lower proportion of lymphocytes (70% [0-100] vs 93% [0-100] of WBCs, p = 0.0085; difference = +3% per 1-year increase of age, p = 0.0011) and higher proportion of neutrophils than later-onset patients (0.5% [0-75] vs 0% [0-50] of WBCs, p = 0.16; difference =-1% per 1-year increase of age, p = 0.033). In earlier-onset disease, fewer patients had an elevated IgG index than in the later-onset group (35% vs 68% of patients, p = 0.031). CONCLUSION: Age modifies the CSF profile at pediatric multiple sclerosis (MS) onset, which may mislead the diagnosis. Our findings suggest an activation of the innate rather than the adaptive immune system in the earlier stages of MS or an immature immune response.

Original languageEnglish (US)
Pages (from-to)399-405
Number of pages7
JournalNeurology
Volume74
Issue number5
DOIs
StatePublished - Feb 2010

Fingerprint

Multiple Sclerosis
Pediatrics
Immunoglobulin G
Leukocyte Count
Oligoclonal Bands
Delayed Diagnosis
Age of Onset
Observational Studies
Immune System
Neutrophils
Age Groups
Databases
Lymphocytes

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Chabas, D., Ness, J., Belman, A., Yeh, E. A., Kuntz, N., Gorman, M. P., ... Waubant, E. (2010). Younger children with MS have a distinct CSF inflammatory profile at disease onset. Neurology, 74(5), 399-405. https://doi.org/10.1212/WNL.0b013e3181ce5db0

Younger children with MS have a distinct CSF inflammatory profile at disease onset. / Chabas, D.; Ness, J.; Belman, A.; Yeh, E. A.; Kuntz, N.; Gorman, M. P.; Strober, J. B.; De Kouchkovsky, I.; McCulloch, C.; Chitnis, T.; Rodriguez, M.; Weinstock-Guttman, B.; Krupp, L. B.; Waubant, E.

In: Neurology, Vol. 74, No. 5, 02.2010, p. 399-405.

Research output: Contribution to journalArticle

Chabas, D, Ness, J, Belman, A, Yeh, EA, Kuntz, N, Gorman, MP, Strober, JB, De Kouchkovsky, I, McCulloch, C, Chitnis, T, Rodriguez, M, Weinstock-Guttman, B, Krupp, LB & Waubant, E 2010, 'Younger children with MS have a distinct CSF inflammatory profile at disease onset', Neurology, vol. 74, no. 5, pp. 399-405. https://doi.org/10.1212/WNL.0b013e3181ce5db0
Chabas D, Ness J, Belman A, Yeh EA, Kuntz N, Gorman MP et al. Younger children with MS have a distinct CSF inflammatory profile at disease onset. Neurology. 2010 Feb;74(5):399-405. https://doi.org/10.1212/WNL.0b013e3181ce5db0
Chabas, D. ; Ness, J. ; Belman, A. ; Yeh, E. A. ; Kuntz, N. ; Gorman, M. P. ; Strober, J. B. ; De Kouchkovsky, I. ; McCulloch, C. ; Chitnis, T. ; Rodriguez, M. ; Weinstock-Guttman, B. ; Krupp, L. B. ; Waubant, E. / Younger children with MS have a distinct CSF inflammatory profile at disease onset. In: Neurology. 2010 ; Vol. 74, No. 5. pp. 399-405.
@article{55202822bf304afda4fe92322223c529,
title = "Younger children with MS have a distinct CSF inflammatory profile at disease onset",
abstract = "BACKGROUND: The clinical and MRI presentation differs between earlier-and later-onset pediatric multiple sclerosis (MS), whereas the effect of age on the CSF inflammatory profile is unknown and may contribute to delayed diagnosis. OBJECTIVES: To compare the CSF cellular and immunoglobulin G (IgG) profiles between earlier-and later-onset pediatric MS. METHODS: We queried the databases of 6 pediatric MS centers for earlier-onset (onset <11 years) and later-onset ({\^a}‰111 and <18 years) patients with MS or clinically isolated syndrome who underwent CSF analysis within the first 3 months of presentation (observational study). We compared CSF white blood cell (WBC) differential count, IgG index, and IgG oligoclonal bands between age groups. RESULTS: We identified 40 earlier-onset (mean age at onset = 7.2 ± 2.7 years, 60{\%} females) and 67 later-onset pediatric MS patients (15.1 ± 1.7 years, 63{\%} females). Although WBC count tended to be higher in earlier-onset patients (median = 9/mm [0-343] vs 6 [0-140], p = 0.15), they had a lower proportion of lymphocytes (70{\%} [0-100] vs 93{\%} [0-100] of WBCs, p = 0.0085; difference = +3{\%} per 1-year increase of age, p = 0.0011) and higher proportion of neutrophils than later-onset patients (0.5{\%} [0-75] vs 0{\%} [0-50] of WBCs, p = 0.16; difference =-1{\%} per 1-year increase of age, p = 0.033). In earlier-onset disease, fewer patients had an elevated IgG index than in the later-onset group (35{\%} vs 68{\%} of patients, p = 0.031). CONCLUSION: Age modifies the CSF profile at pediatric multiple sclerosis (MS) onset, which may mislead the diagnosis. Our findings suggest an activation of the innate rather than the adaptive immune system in the earlier stages of MS or an immature immune response.",
author = "D. Chabas and J. Ness and A. Belman and Yeh, {E. A.} and N. Kuntz and Gorman, {M. P.} and Strober, {J. B.} and {De Kouchkovsky}, I. and C. McCulloch and T. Chitnis and M. Rodriguez and B. Weinstock-Guttman and Krupp, {L. B.} and E. Waubant",
year = "2010",
month = "2",
doi = "10.1212/WNL.0b013e3181ce5db0",
language = "English (US)",
volume = "74",
pages = "399--405",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Younger children with MS have a distinct CSF inflammatory profile at disease onset

AU - Chabas, D.

AU - Ness, J.

AU - Belman, A.

AU - Yeh, E. A.

AU - Kuntz, N.

AU - Gorman, M. P.

AU - Strober, J. B.

AU - De Kouchkovsky, I.

AU - McCulloch, C.

AU - Chitnis, T.

AU - Rodriguez, M.

AU - Weinstock-Guttman, B.

AU - Krupp, L. B.

AU - Waubant, E.

PY - 2010/2

Y1 - 2010/2

N2 - BACKGROUND: The clinical and MRI presentation differs between earlier-and later-onset pediatric multiple sclerosis (MS), whereas the effect of age on the CSF inflammatory profile is unknown and may contribute to delayed diagnosis. OBJECTIVES: To compare the CSF cellular and immunoglobulin G (IgG) profiles between earlier-and later-onset pediatric MS. METHODS: We queried the databases of 6 pediatric MS centers for earlier-onset (onset <11 years) and later-onset (â‰111 and <18 years) patients with MS or clinically isolated syndrome who underwent CSF analysis within the first 3 months of presentation (observational study). We compared CSF white blood cell (WBC) differential count, IgG index, and IgG oligoclonal bands between age groups. RESULTS: We identified 40 earlier-onset (mean age at onset = 7.2 ± 2.7 years, 60% females) and 67 later-onset pediatric MS patients (15.1 ± 1.7 years, 63% females). Although WBC count tended to be higher in earlier-onset patients (median = 9/mm [0-343] vs 6 [0-140], p = 0.15), they had a lower proportion of lymphocytes (70% [0-100] vs 93% [0-100] of WBCs, p = 0.0085; difference = +3% per 1-year increase of age, p = 0.0011) and higher proportion of neutrophils than later-onset patients (0.5% [0-75] vs 0% [0-50] of WBCs, p = 0.16; difference =-1% per 1-year increase of age, p = 0.033). In earlier-onset disease, fewer patients had an elevated IgG index than in the later-onset group (35% vs 68% of patients, p = 0.031). CONCLUSION: Age modifies the CSF profile at pediatric multiple sclerosis (MS) onset, which may mislead the diagnosis. Our findings suggest an activation of the innate rather than the adaptive immune system in the earlier stages of MS or an immature immune response.

AB - BACKGROUND: The clinical and MRI presentation differs between earlier-and later-onset pediatric multiple sclerosis (MS), whereas the effect of age on the CSF inflammatory profile is unknown and may contribute to delayed diagnosis. OBJECTIVES: To compare the CSF cellular and immunoglobulin G (IgG) profiles between earlier-and later-onset pediatric MS. METHODS: We queried the databases of 6 pediatric MS centers for earlier-onset (onset <11 years) and later-onset (â‰111 and <18 years) patients with MS or clinically isolated syndrome who underwent CSF analysis within the first 3 months of presentation (observational study). We compared CSF white blood cell (WBC) differential count, IgG index, and IgG oligoclonal bands between age groups. RESULTS: We identified 40 earlier-onset (mean age at onset = 7.2 ± 2.7 years, 60% females) and 67 later-onset pediatric MS patients (15.1 ± 1.7 years, 63% females). Although WBC count tended to be higher in earlier-onset patients (median = 9/mm [0-343] vs 6 [0-140], p = 0.15), they had a lower proportion of lymphocytes (70% [0-100] vs 93% [0-100] of WBCs, p = 0.0085; difference = +3% per 1-year increase of age, p = 0.0011) and higher proportion of neutrophils than later-onset patients (0.5% [0-75] vs 0% [0-50] of WBCs, p = 0.16; difference =-1% per 1-year increase of age, p = 0.033). In earlier-onset disease, fewer patients had an elevated IgG index than in the later-onset group (35% vs 68% of patients, p = 0.031). CONCLUSION: Age modifies the CSF profile at pediatric multiple sclerosis (MS) onset, which may mislead the diagnosis. Our findings suggest an activation of the innate rather than the adaptive immune system in the earlier stages of MS or an immature immune response.

UR - http://www.scopus.com/inward/record.url?scp=76349099319&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=76349099319&partnerID=8YFLogxK

U2 - 10.1212/WNL.0b013e3181ce5db0

DO - 10.1212/WNL.0b013e3181ce5db0

M3 - Article

C2 - 20124205

AN - SCOPUS:76349099319

VL - 74

SP - 399

EP - 405

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 5

ER -