Multiple Sclerosis increasing in teens – at least 2X in 9 years

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Hospital admission rates for pediatric multiple sclerosis in the United States using the Pediatric Health Information System (PHIS) – 2016

Multiple Sclerosis and Related Disorders, September 2016, Pages 5 - 10
Amy M. Lavery ⁎, Brenda L. Banwell, Geraldine Liu and Amy T. Waldman
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Background
The onset of multiple sclerosis (MS) during childhood or adolescence is increasingly recognized in the United States. Administrative databases quantify healthcare utilization as measured by hospital admissions, providing insight into the impact of MS in the pediatric population.

Objective
We examine the frequency of hospital admissions for pediatric MS in the US using the Pediatric Health Information System (PHIS) database.

Methods
Data was extracted from the PHIS database using the ICD-9 code for MS (340.00) and reviewed to verify case ascertainment. Mean, median, and range values were determined for the number of inpatient hospitalizations per patient, number of days in the hospital, and cost of each encounter. A trend analysis was performed to evaluate the annual frequency of MS-related admissions over the study period.

Results
After case verification, the PHIS database extraction reported 2068 hospital inpatient encounters for 1422 unique pediatric MS patients between 2004 and 2013. The median number of hospitalizations per patient was 2 with a median hospital stay of 4 days. Admission rates for MS increased from 2.37 per 10,000 in 2004 to 4.13 per 10,000 in 2013.

Conclusion
The number of admissions due to pediatric MS has increased since the start of the PHIS database collection, concurrent with increased disease awareness and the establishment of dedicated pediatric MS centers.

Highlights
The Pediatric Health Information System database was extracted to determine the hospital admission rate for pediatric MS in the U.S.

• The hospital admission rate due to pediatric MS has increased from 2.37 per 10,000 patients in 2004 to 4.13 per 10,000 patients in 2013.
• Although the number of pediatric MS admissions has steadily increased in patients over 11, the number has remained relatively stable in the under 11 age group.
• Pediatric MS is a serious illness associated with frequent hospitalization and with substantive health care costs (costs averaged $38,000 per admission).

Clipped from PDF “. . . we have underestimated children with MS who were hospitalized for their incident MS attack, but not hospitalized subsequently once their MS diagnosis was confirmed (ie: none of their further relapses required hospital care)”

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Pediatric-Onset Multiple Sclerosis: A Single Center Study – Dec 2017

Journal of Child Neurology, December 15, 2017, DOI: 10.1177/0883073817739789
Erin Yamamoto, BA, Matthew Ginsberg, MD, Mary Rensel, MD, ...

Pediatric-onset multiple sclerosis (POMS), once thought to be rare, is now being diagnosed in increasing numbers in children. Despite improvements to diagnostic criteria, the diagnosis and management of POMS remains challenging. The aim of this study is to retrospectively describe a growing POMS patient population seen at a single center over a 13 year period. Epidemiologic, clinical, neuroimaging, laboratory features and therapeutic management and outcome data were collected and analyzed. These data support associations between MS and environmental triggers such as obesity and vitamin D deficiency. Presenting symptoms, magnetic resonance imaging and laboratory findings were consistent with the existing literature; however, the prevalence of cortical lesions and abnormal saccadic pursuit is higher than other reports. Data also demonstrate a shift in practice from first- to second-line therapies over the observed period.
PDF of 2017 study is behind publisher paywall

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Vitamin D status is associated with relapse rate in pediatric-onset multiple sclerosis - 2010

Ann Neurol. 2010 May;67(5):618-24. doi: 10.1002/ana.21972
Mowry EM1, Krupp LB, Milazzo M, Chabas D, Strober JB, Belman AL, McDonald JC, Oksenberg JR, Bacchetti P, Waubant E.
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OBJECTIVE:
We sought to determine if vitamin D status, a risk factor for multiple sclerosis, is associated with the rate of subsequent clinical relapses in pediatric-onset multiple sclerosis.

METHODS:
This is a retrospective study of patients with pediatric-onset multiple sclerosis or clinically isolated syndrome who were consecutively recruited into a prospective cohort at their clinical visit at the pediatric multiple sclerosis center of University of California, San Francisco or State University of New York at Stony Brook. Of 171 eligible patients, 134 (78%) with multiple sclerosis/clinically isolated syndrome were included in the cohort; a further 24 were excluded from this analysis due to lack of available serum (n = 7) or lack of follow-up (n = 17). Serum 25-hydroxyvitamin D(3) levels were measured and were adjusted to reflect a deseasonalized value. The adjusted serum 25-hydroxyvitamin D(3) level was the primary predictor in a multivariate negative binomial regression model in which the main outcome measure was the number of subsequent relapses.

RESULTS:
Among the 110 subjects, the mean unadjusted 25-hydroxyvitamin D(3) level was 22 +/- 9 ng/ml. After adjustment for age, gender, race, ethnicity, disease duration, disease-modifying therapy, and length of follow-up, every 10 ng/ml increase in the adjusted 25-hydroxyvitamin D(3) level was associated with a 34% decrease in the rate of subsequent relapses (incidence rate ratio, 0.66; 95% confidence interval, 0.46-0.95; p = 0.024).

INTERPRETATION:
Lower serum 25-hydroxyvitamin D(3) levels are associated with a substantially increased subsequent relapse rate in pediatric-onset multiple sclerosis or clinically isolated syndrome, providing rationale for a randomized controlled trial of vitamin D supplementation.