Characteristics of pediatric multiple sclerosis: The Turkish pediatric multiple sclerosis database

Eur J Paediatr Neurol. 2017 Nov;21(6):864-872. doi: 10.1016/j.ejpn.2017.06.004. Epub 2017 Jun 29.


Objective: To document the clinical and paraclinical features of pediatric multiple sclerosis (MS) in Turkey.

Methods: Data of MS patients with onset before age 18 years (n = 193) were collected from 27 pediatric neurology centers throughout Turkey. Earlier-onset (<12 years) and later-onset (≥12 years) groups were compared.

Results: There were 123 (63.7%) girls and 70 (36.3%) boys aged 4-17 years, median 14 years at disease onset. Family history of MS was 6.5%. The first presentation was polysymptomatic in 55.4% of patients, with brainstem syndromes (50.3%), sensory disturbances (44%), motor symptoms (33.2%), and optic neuritis (26.4%) as common initial manifestations. Nineteen children had facial paralysis and 10 had epileptic seizures at first attack; 21 (11%) were initially diagnosed with acute disseminated encephalomyelitis (ADEM). Oligoclonal bands were identified in 68% of patients. Magnetic resonance imaging revealed periventricular (96%), cortical/juxtacortical (64.2%), brainstem (63%), cerebellum (51.4%), and spinal cord (67%) involvement. Visual evoked potentials (VEP) were abnormal in 52%; serum 25-hydroxyvitamin D levels were low in 68.5% of patients. The earlier-onset group had a higher rate of infection/vaccination preceding initial attack, initial diagnosis of ADEM, longer interval between first 2 attacks, and more disability accumulating in the first 3 years of the disease.

Conclusion: Brainstem and cerebellum are common sites of clinical and radiological involvement in pediatric-onset MS. VEP abnormalities are frequent even in patients without history of optic neuropathy. Vitamin D status does not appear to affect the course in early disease. MS beginning before 12 years of age has certain characteristics in history and course.

Keywords: Imaging; Magnetic resonance; Multiple sclerosis; Pediatric; Relapse; Visual evoked potentials; Vitamin D.

MeSH terms

  • Adolescent
  • Brain / pathology*
  • Brain / physiopathology
  • Child
  • Child, Preschool
  • Evoked Potentials, Visual
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Multiple Sclerosis / epidemiology
  • Multiple Sclerosis / pathology*
  • Multiple Sclerosis / physiopathology*
  • Spinal Cord / pathology*
  • Spinal Cord / physiopathology
  • Turkey / epidemiology
  • Vitamin D / analogs & derivatives
  • Vitamin D / blood


  • Vitamin D
  • 25-hydroxyvitamin D