The Study Of Influencing Factors To The Early Relapse Of Multiple Sclerosis Children

Objective: To study the clinical features of children with MS,to discover the factors influencing the early relapse in MS children by comparing the clinical features of children with high-frequency relapse rate with the ones with low-frequency relapse rate in the early stage of the disease, to provide evidence for MS disease activity evaluation,disease prognosis assessment and early intervention.Methods: The clinical and imaging data of thirty-three MS children admitted to affiliated children’s hospital of chongqing medical university from January 2010 to January 2013 are analyzed and compared by retrospective study methods;All of them meet the 2013 revision of multiple sclerosis diagnosis standard formulated by IPMSSG for children. Taking epidemiological studies abroad as reference,defining acute demyelinating events occuring 3 or more times in the first year as the division standard to divide the cases into high-frequency relapse group and low-frequency relapse group in order to study the difference of clinical features between the groups. Using SPSS19.0 statistical software to process the data.Results:(1) In the 33 cases of multiple sclerosis,72% of them relapse in the first year, average number of attacks of the cases< 11 years and the cases≥ 11 years in the first year are(2.11±0.79,1.80±0.10), including the first attack. The number In the secoud year are(0.57±0.62、0.33±0.57).(2)incentive factor of attacks: infection(27 cases, 82%), life stress events(5 cases, 15%), reduction of hormone in the treatment(3 cases, 9%), menarche(3cases, 6%).(3) Epidemiologically, There is no statistically significance in the relapse rate in the first year as for the onset age or gender(P > 0.05).(4)Symptoms of attacks and follows-up: the cases with imcomplete remission in the intervals suffers more attacks than the ones remitting completely(P< 0.05). There is no statistically significance between the two groups in the onset symptoms, severe cases, the affected scope of functional system, encephalopathy cases and cognitive impairment(P>0.05);(5)Imaging examination: Cases with abnormal baseline spinal MRI suffers more attacks in the first year than those with normal ones(P<0.05).There is no statistically significance in the relapse rate in the first year whether there is strengthened lesions in the baseline enhancement MRI or not(P > 0.05).As for the other parts involved in the baseline MRI, the number of affected areas in the baseline MRI and MRI in the whole course,the number of cases fullfil the 2010 McDonald DIS criteria or the 2016 MAGNIMS DIS criteria, there is no statistically significance between the two groups(P>0.05).(5)Auxiliary examination:Cases with positive OCB serum results suffers more attacks in the first year than those with normal ones(P < 0.05).There is no statistically significance in the relapse rate in the first year whether SEP are abnormal or not(P > 0.05).There is no statistically significant difference between the two groups in VEP abnormal rate and CSF abnormal rate(P > 0.05).Conclusion:(1)Most of the children will have the first relapse in the first year, yearly relapse rate in the first year is the highest of all.(2)Infection, life stress events, reduction of hormone in the treatment and menarche may be the incentive factor of relapse.(3)In our research, imcomplete remission in the relapse intervals,abnormality of baseline spinal MRI or spinal MRI in the whole course and positive OCB serum results may be the risk factor to the early and high-frequency relapse in children with MS.These characteristics may be a implication to the disease activity of MS in the early stage. As for the children suffering high-frequency attacks with spinal cord lesions,it is very necessary to take samples for AQP4 serurm check to make a correct diagnosis and prognosis estimation.