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ARTICLES: M. P. Amato, B. Goretti, A. Ghezzi, S. Lori, V. Zipoli, E. Portaccio, L. Moiola, M. Falautano, M. F. De Caro, M. Lopez, F. Patti, R. Vecchio, C. Pozzilli, V. Bianchi, M. Roscio, G. Comi, M. Trojano For the Multiple Sclerosis Study Group of the Italian Neurological Society Cognitive and psychosocial features of childhood and juvenile MS Neurology 2008; 70: 1891-1897 [Abstract] [Full text] [PDF]

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Cognitive and psychosocial features of childhood and juvenile MS

Hadi Hussain, Ahmad Usman,Qasim Raza   (8 August 2008)

Reply from the authors

Maria Pia Amato, B Goretti, A Ghezzi, S Lori, V Zipoli, E Portaccio, L Moiola, M Falautano , MF De Caro, M Lopez, F Patti, R Vecchio, C Pozzilli, V Bianchi, M Roscio, G Comi, M Trojano for the MS Study group of the Italian Neuorological Society   (8 August 2008)

Cognitive and psychosocial features of childhood and juvenile MS 8 August 2008
Hadi Hussain, Department of Internal Medicine, Combined Military Hospital Room No 18,CMH Officer Mess, Abdul Rehman Road,Saddar,Lahore,Pakistan, Ahmad Usman,Qasim Raza Send Correspondence to journal: Re: Cognitive and psychosocial features of childhood and juvenile MS hadimeeran{at}yahoo.com Hadi Hussain, et al.	Amato et al. compared cognitive and psychosocial functioning in a group of children and adolescents with MS to an age-matched cohort of healthy controls. [1] In the MS group, the prevalence of cognitive impairment was significant for 31% (failed three tests) of participants and minor for 53% (failed two tests). Patients with MS in the cognitively impaired group (n=20) struggled in the areas of memory (especially visuo-spatial), complex attention, verbal comprehension and executive functions. [1] The authors did not report if any of the healthy controls failed two or more tests. In agreement with some adult studies, the Expanded Disability Status Scale (EDSS) and the number of relapses were not adequate to predict cognitive status. In a multivariate logistic regression analysis that included age, sex, educational level, age at onset, number of relapses in the past two years, EDSS score, disease-modifying treatment and IQ, only IQ was found to be a significant predictor of cognitive dysfunction. Unexpectedly, there was no significant statistical difference in the mean IQ score between the MS group and the healthy control group. The proportion of subjects yielding lower IQ scores was significantly higher in the MS group; fifteen (28%) patients with IQs 70-89 and five (8%) patients with an IQ of <70. This compared to only two healthy controls with a score 70-89 and no healthy controls with an IQ of <70. Perhaps there were too few subjects to show a statistically significant difference between the groups. The relatively high proportion of patients with low IQ in the MS group is noteworthy. When using fatigue scores in the 5th percentile of healthy controls, the authors reported that 73% of patients with MS were fatigued. Another important shortcoming of this study is that fatigue was not included in the logistic regression analysis and this may have an effect on neuropsychological testing. Finally, reports of depression in patients with MS was low (6%) compared to previous reports on this age group (50%). [2,3] However, we are concerned by the potential insensitivity of the depression screening tool used in this study and its inability to capture depression and assess its impact on cognitive outcome measures. References 1. Amato MP, Goretti B, A Ghezzi A et al,et al. Cognitive and psychosocial features of childhood and juvenile MS.Neurology 2008;70:1891-1897. 2.Sadovnick AD, Remick RA, Allen J, et al. Depression and multiple sclerosis. Neurology 1996;46:628-632. 3.Beiske AG, Svensson E, Sandanger I, et al .Depression and anxiety amongst multiple sclerosis patients.Eur J Neurol 2008;15:239-225. Disclosures: The authors report no disclosures.
Reply from the authors 8 August 2008
Maria Pia Amato, Department of Neurology, University of Flo viale Morgagni 85, 50134 Florence Italy, B Goretti, A Ghezzi, S Lori, V Zipoli, E Portaccio, L Moiola, M Falautano , MF De Caro, M Lopez, F Patti, R Vecchio, C Pozzilli, V Bianchi, M Roscio, G Comi, M Trojano for the MS Study group of the Italian Neuorological Society Send Correspondence to journal: Re: Reply from the authors mariapia.amato{at}unifi.it Maria Pia Amato, et al.	We thank Dr. Hussain et al. for their interest in our article and for the opportunity to better clarify some aspects of our work. [1] We assessed overall cognitive functioning in MS cases relying on the distribution of the number of tests failed in the healthy control group. In particular, two (3.5%) healthy subjects failed at least three tests versus 19 (31%) MS patients, and eight (14%) failed at least two tests versus 32 (53%) MS cases. These findings further highlight the impact of MS on cognition in these age ranges. Beyond the 31% of cases showing significant cognitive dysfunction, another 22% exhibited milder degrees of cognitive impairment. Dr Hussain et al. mention the absence of a significant statistical difference between patients and controls in terms of mean values of IQ. However, this is due to the specific selection of a subgroup of controls with IQ values comparable to those of MS cases. Nevertheless, when grouping the patients on the basis of their performance, the difference emerged. Moreover, we applied the Bonferroni correction for multiple testing, lowering the statistical significance threshold to p<0.005. Concerning fatigue, there were no differences between cases and controls in terms of the Fatigue Severity Score (FSS) so we did not include this variable in the regression model. However, even when we repeated the analysis including fatigue scores, the results did not change and the IQ remained the only significant predictor of cognitive dysfunction (data not shown in the paper). Finally, we agree with Dr. Hussain et al. on the potential insensitivity of the instrument used for the screening of depression. To gauge a better understanding of depressive symptoms in children and adolescents with MS, we have included a psychiatric interview in the ongoing follow-up evaluation of our cohort. Disclosure: The study to which this correspondence refers was supported in part by a grant from Biogen-Dompè.