Clinical and radiological study of Iraqi multiple sclerosis patients with childhood onset

OBJECTIVE: To study the clinical and radiological characteristics of multiple sclerosis (MS) with onset below 18 years.

METHODS: This retrospective study was carried out at the MS Clinic in the Medical City Hospital in Baghdad, Iraq between March 2008 and March 2009. The records of the center were surveyed, and 77 patients with the onset of MS below 18 years were identified. Their clinical and radiological data were then analyzed.

RESULTS: The female:male ratio was 1.6:1, and the mean age at onset was 14.95 years. Seven (9.1%) patients where children (age below 10 years), and 70 (90.9%) patients where adolescents (age 10-18 years) at onset. Seventy patients (90.9%) had an initial course of relapsing remitting MS, 9 (11.7% of the total) of them progressed to secondary progressive MS after a mean duration of 9.87+/-4.135 years. Seven patients had primary progressive MS as the initial course. The most common presenting symptom was optic neuritis (35.8%). Fifty-nine (76.6%) patients had monofocal presentation, and 18 (23.4%) had polyfocal presentation. Fifty-one (63%) patients had periventricular MRI lesions. The percentage of supratentorial lesions was higher than infratentorial lesions, children had a higher incidence of basal ganglionic lesions than adolescents (p=0.002), and males had a higher incidence of infratentorial lesion than females (p=0.033).

CONCLUSION: Male patients have a higher incidence of infratentorial MRI lesions than female patients. Children had a higher incidence of MRI lesions in the basal ganglia than adolescents.