The Outcome of COVID-19 in Pediatric-Onset Multiple Sclerosis Patients

Ibrahim Oncel; Nurettin Alici; Ismail Solmaz; Dogan Dinc Oge; Yasemin Ozsurekci; Banu Anlar

doi:10.1016/j.pediatrneurol.2022.06.004

The Outcome of COVID-19 in Pediatric-Onset Multiple Sclerosis Patients

Pediatr Neurol. 2022 Sep:134:7-10. doi: 10.1016/j.pediatrneurol.2022.06.004. Epub 2022 Jun 10.

Authors

Ibrahim Oncel¹, Nurettin Alici², Ismail Solmaz², Dogan Dinc Oge³, Yasemin Ozsurekci⁴, Banu Anlar²

Affiliations

¹ Department of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey. Electronic address: dribrahimoncel@gmail.com.
² Department of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
³ Department of Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
⁴ Department of Pediatric Infectious Disease, Hacettepe University Faculty of Medicine, Ankara, Turkey.

PMID: 35772229
PMCID: PMC9186527
DOI: 10.1016/j.pediatrneurol.2022.06.004

Abstract

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.

Keywords: COVID-19; Disease-modifying therapy; Pediatric-onset multiple sclerosis; Severity.

MeSH terms

Adult
COVID-19* / complications
Child
Cross-Sectional Studies
Humans
Multiple Sclerosis* / complications
Multiple Sclerosis* / drug therapy
Multiple Sclerosis* / epidemiology
Pandemics
SARS-CoV-2