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Armangue T, Whitehead MT, Tonduti D, Farina L, Tavasoli AR, Vossough A, Bennett ML, Vaia Y, Bernard G, Salsano E, Mercimek-Andrews S, Waldman A, Vanderver A. Brainstem Chipmunk Sign: A Diagnostic Imaging Clue across All Subtypes of Alexander Disease. AJNR Am J Neuroradiol 2024:ajnr.A8220. [PMID: 38697787 DOI: 10.3174/ajnr.a8220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/01/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND AND PURPOSE While classic brain MR imaging features of Alexander disease have been well-documented, lesional patterns can overlap with other leukodystrophies, especially in the early stages of the disease or in milder phenotypes. We aimed to assess the utility of a new neuroimaging sign to help increase the diagnostic specificity of Alexander disease. MATERIALS AND METHODS A peculiar bilateral symmetric hyperintense signal on T2-weighted images affecting the medulla oblongata was identified in an index patient with type I Alexander disease. Subsequently, 5 observers performed a systematic MR imaging review for this pattern by examining 55 subjects with Alexander disease and 74 subjects with other leukodystrophies. Interobserver agreement was assessed by the κ index. Sensitivity, specificity, and receiver operating characteristic curves were determined. RESULTS The identified pattern was present in 87% of subjects with Alexander disease and 14% of those without Alexander disease leukodystrophy (P < .001), 3 with vanishing white matter, 4 with adult polyglucosan body disease, and 3 others. It was found equally in both type I and type II Alexander disease (28/32, 88% versus 18/21, 86%; P = .851) and in subjects with unusual disease features (2/2). Sensitivity (87.3%; 95% CI, 76.0%-93.7%), specificity (86.5%; 95% CI, 76.9%-92.5%), and interobserver agreement (κ index = 0.82) were high. CONCLUSIONS The identified pattern in the medulla oblongata, called the chipmunk sign due to its resemblance to the face of this rodent, is extremely common in subjects with Alexander disease and represents a diagnostic tool that can aid in early diagnosis, especially in subjects with otherwise atypical MR imaging findings and/or clinical features.
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Affiliation(s)
- Thaís Armangue
- From the Neuroimmunology Program (T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona, Barcelona, Spain
- Neurology Department (T.A.), Neuroimmunology Unit, Sant Joan de Deu Children's Hospital, University of Barcelona, Barcelona, Spain
| | - Matthew T Whitehead
- Department of Radiology (M.T.W., A.Vossough), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine (M.T.W., A.Vossough, A.W., A.Vanderver), University of Pennsylvania, Philadelphia, Pennsylvania
| | - Davide Tonduti
- Unit of Pediatric Neurology (D.T., Y.V.), Center for Diagnosis and Treatment of Leukodystrophies, V. Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Laura Farina
- Neuroimaging Laboratory (L.F.), IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Ali Reza Tavasoli
- Department of Neurology (A.R.T.), Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurology (A.R.T.), Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, Arizona
| | - Arastoo Vossough
- Department of Radiology (M.T.W., A.Vossough), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine (M.T.W., A.Vossough, A.W., A.Vanderver), University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mariko L Bennett
- Division of Neurology (M.L.B., Y.V., A.W., A.Vanderver), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ylenia Vaia
- Unit of Pediatric Neurology (D.T., Y.V.), Center for Diagnosis and Treatment of Leukodystrophies, V. Buzzi Children's Hospital, University of Milan, Milan, Italy
- Division of Neurology (M.L.B., Y.V., A.W., A.Vanderver), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Geneviève Bernard
- Departments of Neurology and Neurosurgery, Pediatrics, and Human Genetics (G.B.), McGill University, Montreal, Quebec, Canada
- Department of Specialized Medicine (G.B.), Division of Medical Genetics, McGill University Health Centre, Montreal, Quebec, Canada
- Child Health and Human Development Program (G.B.), Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Ettore Salsano
- Unit of Rare Neurological Diseases (E.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Saadet Mercimek-Andrews
- Department of Medical Genetics (S.M.-A.), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- The Hospital for Sick Children (S.M.-A.), Toronto, Ontario, Canada
| | - Amy Waldman
- Perelman School of Medicine (M.T.W., A.Vossough, A.W., A.Vanderver), University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Neurology (M.L.B., Y.V., A.W., A.Vanderver), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Adeline Vanderver
- Perelman School of Medicine (M.T.W., A.Vossough, A.W., A.Vanderver), University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Neurology (M.L.B., Y.V., A.W., A.Vanderver), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Schoeps VA, Zhou X, Horton MK, Zhu F, McCauley KE, Nasr Z, Virupakshaiah A, Gorman MP, Benson LA, Weinstock‐Guttman B, Waldman A, Banwell BL, Bar‐Or A, Marrie RA, van Domselaar G, O'Mahony J, Mirza AI, Bernstein CN, Yeh EA, Casper TC, Lynch SV, Tremlett H, Baranzini S, Waubant E. Short-chain fatty acid producers in the gut are associated with pediatric multiple sclerosis onset. Ann Clin Transl Neurol 2024; 11:169-184. [PMID: 37955284 PMCID: PMC10791026 DOI: 10.1002/acn3.51944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023] Open
Abstract
OBJECTIVE The relationship between multiple sclerosis and the gut microbiome has been supported by animal models in which commensal microbes are required for the development of experimental autoimmune encephalomyelitis. However, observational study findings in humans have only occasionally converged when comparing multiple sclerosis cases and controls which may in part reflect confounding by comorbidities and disease duration. The study of microbiome in pediatric-onset multiple sclerosis offers unique opportunities as it is closer to biological disease onset and minimizes confounding by comorbidities and environmental exposures. METHODS A multicenter case-control study in which 35 pediatric-onset multiple sclerosis cases were 1:1 matched to healthy controls on age, sex, self-reported race, ethnicity, and recruiting site. Linear mixed effects models, weighted correlation network analyses, and PICRUSt2 were used to identify microbial co-occurrence networks and for predicting functional abundances based on marker gene sequences. RESULTS Two microbial co-occurrence networks (one reaching significance after adjustment for multiple comparisons; q < 0.2) were identified, suggesting interdependent bacterial taxa that exhibited association with disease status. Both networks indicated a potentially protective effect of higher relative abundance of bacteria observed in these clusters. Functional predictions from the significant network suggested a contribution of short-chain fatty acid producers through anaerobic fermentation pathways in healthy controls. Consistent family-level findings from an independent Canadian-US study (19 case/control pairs) included Ruminococaccaeae and Lachnospiraceae (p < 0.05). Macronutrient intake was not significantly different between cases and controls, minimizing the potential for dietary confounding. INTERPRETATION Our results suggest that short-chain fatty acid producers may be important contributors to multiple sclerosis onset.
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Affiliation(s)
- Vinicius A. Schoeps
- Department of NeurologyUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Xiaoyuan Zhou
- Department of NeurologyUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Mary K. Horton
- Division of EpidemiologyUniversity of California, BerkeleyBerkeleyCaliforniaUSA
| | - Feng Zhu
- Division of NeurologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Kathryn E. McCauley
- Department of NeurologyUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Zahra Nasr
- Department of NeurologyUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Akash Virupakshaiah
- Department of NeurologyUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Mark P. Gorman
- Department of NeurologyBoston Children's HospitalBostonMassachusettsUSA
| | - Leslie A. Benson
- Department of NeurologyBoston Children's HospitalBostonMassachusettsUSA
| | | | - Amy Waldman
- Department of NeurologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Brenda L. Banwell
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Amit Bar‐Or
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ruth Ann Marrie
- Department of Internal MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Gary van Domselaar
- Department of Internal MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Julia O'Mahony
- Department of Internal MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Ali I. Mirza
- Division of NeurologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | | | - E. Ann Yeh
- The Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | | | - Susan V. Lynch
- Department of NeurologyUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Helen Tremlett
- Division of NeurologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Sergio Baranzini
- Department of NeurologyUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Emmanuelle Waubant
- Department of NeurologyUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
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Rodden LN, McIntyre K, Keita M, Wells M, Park C, Profeta V, Waldman A, Rummey C, Balcer LJ, Lynch DR. Retinal hypoplasia and degeneration result in vision loss in Friedreich ataxia. Ann Clin Transl Neurol 2023; 10:1397-1406. [PMID: 37334854 PMCID: PMC10424660 DOI: 10.1002/acn3.51830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/16/2023] [Accepted: 05/26/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVE Friedreich ataxia (FRDA) is an inherited condition caused by a GAA triplet repeat (GAA-TR) expansion in the FXN gene. Clinical features of FRDA include ataxia, cardiomyopathy, and in some, vision loss. In this study, we characterize features of vision loss in a large cohort of adults and children with FRDA. METHODS Using optical coherence tomography (OCT), we measured peripapillary retinal nerve fiber layer (RNFL) thickness in 198 people with FRDA, and 77 controls. Sloan letter charts were used to determine visual acuity. RNFL thickness and visual acuity were compared to measures of disease severity obtained from the Friedreich Ataxia Clinical Outcomes Measures Study (FACOMS). RESULTS The majority of patients, including children, had pathologically thin RNFLs (mean = 73 ± 13 μm in FRDA; 98 ± 9 μm in controls) and low-contrast vision deficits early in the disease course. Variability in RNFL thickness in FRDA (range: 36 to 107 μm) was best predicted by disease burden (GAA-TR length X disease duration). Significant deficits in high-contrast visual acuity were apparent in patients with an RNFL thickness of ≤68 μm. RNFL thickness decreased at a rate of -1.2 ± 1.4 μm/year and reached 68 μm at a disease burden of approximately 12,000 GAA years, equivalent to disease duration of 17 years for participants with 700 GAAs. INTERPRETATION These data suggest that both hypoplasia and subsequent degeneration of the RNFL may be responsible for the optic nerve dysfunction in FRDA and support the development of a vision-directed treatment for selected patients early in the disease to prevent RNFL loss from reaching the critical threshold.
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Affiliation(s)
- Layne N. Rodden
- Departments of Pediatrics and Neurology, Children's Hospital of Philadelphia, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kellie McIntyre
- Departments of Pediatrics and Neurology, Children's Hospital of Philadelphia, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Medina Keita
- Departments of Pediatrics and Neurology, Children's Hospital of Philadelphia, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Mckenzie Wells
- Departments of Pediatrics and Neurology, Children's Hospital of Philadelphia, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Courtney Park
- Departments of Pediatrics and Neurology, Children's Hospital of Philadelphia, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Victoria Profeta
- Departments of Pediatrics and Neurology, Children's Hospital of Philadelphia, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Amy Waldman
- Departments of Pediatrics and Neurology, Children's Hospital of Philadelphia, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Laura J. Balcer
- Departments of Neurology, Population Health and OphthalmologyNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - David R. Lynch
- Departments of Pediatrics and Neurology, Children's Hospital of Philadelphia, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Horton MK, Shim JE, Wallace A, Graves JS, Aaen G, Greenberg B, Mar S, Wheeler Y, Weinstock-Guttman B, Waldman A, Schreiner T, Rodriguez M, Tillema JM, Chitnis T, Krupp L, Casper TC, Rensel M, Hart J, Quach HL, Quach DL, Schaefer C, Waubant E, Barcellos LF. Rare and low-frequency coding genetic variants contribute to pediatric-onset multiple sclerosis. Mult Scler 2023; 29:505-511. [PMID: 36755464 PMCID: PMC10149552 DOI: 10.1177/13524585221150736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND Rare genetic variants are emerging as important contributors to the heritability of multiple sclerosis (MS). Whether rare variants also contribute to pediatric-onset multiple sclerosis (POMS) is unknown. OBJECTIVE To test whether genes harboring rare variants associated with adult-onset MS risk (PRF1, PRKRA, NLRP8, and HDAC7) and 52 major histocompatibility complex (MHC) genes are associated with POMS. METHODS We analyzed DNA samples from 330 POMS cases and 306 controls from the US Network of Pediatric MS Centers and Kaiser Permanente Northern California for which Illumina ExomeChip genotypes were available. Using the gene-based method "SKAT-O," we tested the association between candidate genes and POMS risk. RESULTS After correction for multiple comparisons, one adult-onset MS gene (PRF1, p = 2.70 × 10-3) and two MHC genes (BRD2, p = 5.89 × 10-5 and AGER, p = 7.96 × 10-5) were significantly associated with POMS. Results suggest these are independent of HLA-DRB1*1501. CONCLUSION Findings support a role for rare coding variants in POMS susceptibility. In particular, rare minor alleles within PRF1 were more common among individuals with POMS compared to controls while the opposite was true for rare variants within significant MHC genes, BRD2 and AGER. These genes would not have been identified by common variant studies, emphasizing the merits of investigating rare genetic variation in complex diseases.
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Affiliation(s)
- Mary K Horton
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA/Center for Computational Biology, College of Engineering, University of California, Berkeley, CA, USA
| | - Joan E Shim
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Amelia Wallace
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA/Department of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | - Jennifer S Graves
- Department of Neurosciences, School of Medicine, University of California, San Diego, CA, USA/Department of Neurology, University of California, San Francisco, CA, USA
| | - Gregory Aaen
- Pediatric MS Center, Loma Linda University Children's Hospital, San Bernardino, CA, USA
| | - Benjamin Greenberg
- Department of Neurology, University of Texas Southwestern, Dallas, TX, USA
| | - Soe Mar
- Pediatric-Onset Demyelinating Diseases and Autoimmune Encephalitis Center, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, USA
| | - Yolanda Wheeler
- Alabama Center for Pediatric-Onset Demyelinating Disease, Children's Hospital of Alabama, Birmingham, AL, USA
| | | | - Amy Waldman
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Teri Schreiner
- Children's Hospital Colorado, University of Colorado, Denver, CO, USA
| | - Moses Rodriguez
- Mayo Clinic's Pediatric Multiple Sclerosis Center, Rochester, MN, USA
| | | | - Tanuja Chitnis
- Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital for Children, Boston, MA, USA
| | - Lauren Krupp
- Lourie Center for Pediatric Multiple Sclerosis, Stony Brook Children's Hospital, Stony Brook, NY, USA
| | - T Charles Casper
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Mary Rensel
- Mellen Center, Cleveland Clinic, Cleveland, OH, USA
| | - Janace Hart
- Regional Pediatric MS Center, Neurology, University of California, San Francisco, CA, USA
| | - Hong L Quach
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA/Center for Computational Biology, College of Engineering, University of California, Berkeley, CA, USA
| | - Diana L Quach
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA/Center for Computational Biology, College of Engineering, University of California, Berkeley, CA, USA
| | | | - Emmanuelle Waubant
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Lisa F Barcellos
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA/Center for Computational Biology, College of Engineering, University of California, Berkeley, CA, USA/Kaiser Permanente Division of Research, Oakland, CA, USA
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5
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Gaudioso CM, Mar S, Casper TC, Codden R, Nguyen A, Aaen G, Benson L, Chitnis T, Francisco C, Gorman MP, Goyal MS, Graves J, Greenberg BM, Hart J, Krupp L, Lotze T, Narula S, Pittock SJ, Rensel M, Rodriguez M, Rose J, Schreiner T, Tillema JM, Waldman A, Weinstock-Guttman B, Wheeler Y, Waubant E, Flanagan EP. MOG and AQP4 Antibodies among Children with Multiple Sclerosis and Controls. Ann Neurol 2023; 93:271-284. [PMID: 36088544 PMCID: PMC10576841 DOI: 10.1002/ana.26502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 09/03/2022] [Accepted: 09/06/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the frequency of myelin oligodendrocyte glycoprotein (MOG)-IgG and aquaporin-4 (AQP4)-IgG among patients with pediatric-onset multiple sclerosis (POMS) and healthy controls, to determine whether seropositive cases fulfilled their respective diagnostic criteria, to compare characteristics and outcomes in children with POMS versus MOG-IgG-associated disease (MOGAD), and identify clinical features associated with final diagnosis. METHODS Patients with POMS and healthy controls were enrolled at 14 US sites through a prospective case-control study on POMS risk factors. Serum AQP4-IgG and MOG-IgG were assessed using live cell-based assays. RESULTS AQP4-IgG was negative among all 1,196 participants, 493 with POMS and 703 healthy controls. MOG-IgG was positive in 30 of 493 cases (6%) and zero controls. Twenty-five of 30 patients positive with MOG-IgG (83%) had MOGAD, whereas 5 of 30 (17%) maintained a diagnosis of multiple sclerosis (MS) on re-review of records. MOGAD cases were more commonly in female patients (21/25 [84%] vs 301/468 [64%]; p = 0.044), younger age (mean = 8.2 ± 4.2 vs 14.7 ± 2.6 years; p < 0.001), more commonly had initial optic nerve symptoms (16/25 [64%] vs 129/391 [33%]; p = 0.002), or acute disseminated encephalomyelitis (ADEM; 8/25 [32%] vs 9/468 [2%]; p < 0.001), and less commonly had initial spinal cord symptoms (3/20 [15%] vs 194/381 [51%]; p = 0.002), serum Epstein-Barr virus (EBV) positivity (11/25 [44%] vs 445/468 [95%]; p < 0.001), or cerebrospinal fluid oligoclonal bands (5/25 [20%] vs 243/352 [69%]; p < 0.001). INTERPRETATION MOG-IgG and AQP4-IgG were not identified among healthy controls confirming their high specificity for pediatric central nervous system (CNS) demyelinating disease. Five percent of those with prior POMS diagnoses ultimately had MOGAD; and none had AQP4-IgG positivity. Clinical features associated with a final diagnosis of MOGAD in those with suspected MS included initial ADEM phenotype, younger age at disease onset, and lack of EBV exposure. ANN NEUROL 2023;93:271-284.
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Affiliation(s)
- Cristina M Gaudioso
- Washington University Pediatric MS and other Demyelinating Disease Center, St. Louis, MO, United States
| | - Soe Mar
- Washington University Pediatric MS and other Demyelinating Disease Center, St. Louis, MO, United States
| | - T Charles Casper
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Rachel Codden
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Adam Nguyen
- Department of Neurology and Laboratory Medicine and Pathology and the Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States
| | - Gregory Aaen
- Pediatric Multiple Sclerosis Center at Loma Linda University Children’s Hospital, Loma Linda University, Loma Linda, CA, United States
| | - Leslie Benson
- Pediatric Multiple Sclerosis and Related Disorders Program at Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Tanuja Chitnis
- Partners Pediatric MS Center, Massachusetts General Hospital, Boston, MA, United States
| | - Carla Francisco
- UCSF Regional Pediatric MS Center, San Francisco, CA, United States
| | - Mark P Gorman
- Pediatric Multiple Sclerosis and Related Disorders Program at Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Manu S Goyal
- Washington University Pediatric MS and other Demyelinating Disease Center, St. Louis, MO, United States
| | - Jennifer Graves
- University of California San Diego Health, Rady Children’s Hospital San Diego
| | - Benjamin M Greenberg
- Department of Neurology, University of Texas Southwestern and Children’s Health, Dallas, TX, United States
| | - Janace Hart
- UCSF Regional Pediatric MS Center, San Francisco, CA, United States
| | - Lauren Krupp
- New York University, Pediatric MS Center, Neurology
| | - Timothy Lotze
- The Blue Bird Circle Clinic for Multiple Sclerosis, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Sona Narula
- Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Sean J. Pittock
- Department of Neurology and Laboratory Medicine and Pathology and the Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States
| | - Mary Rensel
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, United States
| | - Moses Rodriguez
- Mayo Clinic Pediatric MS Center, Mayo Clinic, Rochester, MN, United States
| | - John Rose
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Teri Schreiner
- Rocky Mountain MS Center, Children’s Hospital Colorado, University of Colorado, Aurora, CO, United States
| | | | - Amy Waldman
- Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Bianca Weinstock-Guttman
- The Pediatric MS Center at the Jacobs Neurological Institute, State University of New York at Buffalo, Buffalo, NY, United States
| | - Yolanda Wheeler
- Center for Pediatric-Onset Demyelinating Disease at the Children’s of Alabama, University of Alabama, Birmingham, AL, United States
| | | | - Eoin P Flanagan
- Department of Neurology and Laboratory Medicine and Pathology and the Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States
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Islam S, Inglese M, Aravind P, Barwick T, Wang J, O’Neill K, Waldman A, Williams M, Aboagye E. 18F-Fluoropivalate PET/MRI: imaging of treatment naïve patients and patients treated with radiosurgery. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)00930-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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7
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Helman G, Takanohashi A, Hagemann TL, Perng MD, Walkiewicz M, Woidill S, Sase S, Cross Z, Du Y, Zhao L, Waldman A, Haake BC, Fatemi A, Brenner M, Sherbini O, Messing A, Vanderver A, Simons C. Type II Alexander disease caused by splicing errors and aberrant overexpression of an uncharacterized GFAP isoform. Hum Mutat 2022; 43:1344. [PMID: 35920398 DOI: 10.1002/humu.24400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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8
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Brosius SN, Otto W, Waldman A, Russo M, McGuire J. Clinical Reasoning: A 12-Month-Old Male With Staring Episodes, Ataxia, and Right-Sided Weakness. Neurology 2022; 99:805-810. [PMID: 36028321 DOI: 10.1212/wnl.0000000000201233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/27/2022] [Indexed: 11/15/2022] Open
Abstract
Baylisascaris procyonis, or raccoon round worm, is a rare cause of eosinophilic meningoencephalitis with historically poor clinical outcomes. Symptoms of neural larval migrans begin approximately 2-4 weeks after ingestion with fatigue, nausea, fever, and lethargy, then rapidly progress to weakness, incoordination, ataxia, seizures, altered mental status, and finally coma. Only 31 other cases of central nervous system Baylisascaris neural larval migrans have been reported, with over 25% being lethal. Of the remaining cases, all but three were neurologically devastated largely due to delays in diagnosis and treatment. We present a case of an infant Baylisascaris neural larval migrans manifested as right hemiparesis, ataxia, and cortical blindness. Eosinophilia was missed at an outside hospital due to misidentification of eosinophils as monocytes on automated cell differential. Repeated testing of serum and CSF revealed marked eosinophilia consistent with eosinophilic meningoencephalitis, and serum antibody testing through the Centers of Disease Control confirmed Baylisascaris infection. Notably, this child had a remarkably positive outcome with near complete recovery of neurologic function after treatment with albendazole and steroids. While eosinophilic meningoencephalitis is rare, accounting for less than 3% of all lumbar punctures with pleocytosis, this case illustrates: A) the importance of early disease recognition and treatment to improve patient outcomes and B) the fact that automated cell differentials may misidentify eosinophils as monocytes.
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Affiliation(s)
- Stephanie N Brosius
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania .,Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - William Otto
- Infectious Disease, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Amy Waldman
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Neurology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael Russo
- Infectious Disease, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer McGuire
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Neurology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Sebastian P, Cherbuin N, Barcellos LF, Roalstad S, Casper C, Hart J, Aaen GS, Krupp L, Benson L, Gorman M, Candee M, Chitnis T, Goyal M, Greenberg B, Mar S, Rodriguez M, Rubin J, Schreiner T, Waldman A, Weinstock-Guttman B, Graves J, Waubant E, Lucas R. Association Between Time Spent Outdoors and Risk of Multiple Sclerosis. Neurology 2022; 98:e267-e278. [PMID: 34880094 PMCID: PMC8792813 DOI: 10.1212/wnl.0000000000013045] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 10/19/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES This study aims to determine the contributions of sun exposure and ultraviolet radiation (UVR) exposure to risk of pediatric-onset multiple sclerosis (MS). METHODS Children with MS and controls recruited from multiple centers in the United States were matched on sex and age. Multivariable conditional logistic regression was used to investigate the association of time spent outdoors daily in summer, use of sun protection, and ambient summer UVR dose in the year before birth and the year before diagnosis with MS risk, with adjustment for sex, age, race, birth season, child's skin color, mother's education, tobacco smoke exposure, being overweight, and Epstein-Barr virus infection. RESULTS Three hundred thirty-two children with MS (median disease duration 7.3 months) and 534 controls were included after matching on sex and age. In a fully adjusted model, compared to spending <30 minutes outdoors daily during the most recent summer, greater time spent outdoors was associated with a marked reduction in the odds of developing MS, with evidence of dose-response (30 minutes-1 hour: adjusted odds ratio [AOR] 0.48, 95% confidence interval [CI] 0.23-0.99, p = 0.05; 1-2 hours: AOR 0.19, 95% CI 0.09-0.40, p < 0.001). Higher summer ambient UVR dose was also protective for MS (AOR 0.76 per 1 kJ/m2, 95% CI 0.62-0.94, p = 0.01). DISCUSSION If this is a causal association, spending more time in the sun during summer may be strongly protective against developing pediatric MS, as well as residing in a sunnier location.
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Affiliation(s)
- Prince Sebastian
- From the Australian National University Medical School (P.S.), Centre for Research on Ageing, Health and Wellbeing (N.C.), and National Centre for Epidemiology and Population Health (R.L.), Australian National University, Canberra; Division of Epidemiology (L.F.B.), University of California Berkeley; Department of Pediatrics (S.R., C.C.), University of Utah School of Medicine, Salt Lake City; Pediatric Multiple Sclerosis Center (J.H.) and Department of Neurology (E.W.), University of California San Francisco; Pediatric Multiple Sclerosis Center (G.S.A.), Loma Linda University Children's Hospital, CA; MS Comprehensive Care Center (L.K.), New York University Langone, NY; Pediatric Multiple Sclerosis and Related Disorders Program (L.B., M. Gorman), Boston Children's Hospital, MA; Division of Pediatric Neurology (M.C.), University of Utah Primary Children's Hospital, Salt Lake City; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Department of Radiology (M. Goyal), Washington University St. Louis, MO; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric-Onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Mayo Clinic Pediatric Multiple Sclerosis Center (M.R.), Mayo Clinic, Rochester, MN; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, State University of New York Buffalo; and Department of Neurosciences (J.G.), University of California San Diego
| | - Nicolas Cherbuin
- From the Australian National University Medical School (P.S.), Centre for Research on Ageing, Health and Wellbeing (N.C.), and National Centre for Epidemiology and Population Health (R.L.), Australian National University, Canberra; Division of Epidemiology (L.F.B.), University of California Berkeley; Department of Pediatrics (S.R., C.C.), University of Utah School of Medicine, Salt Lake City; Pediatric Multiple Sclerosis Center (J.H.) and Department of Neurology (E.W.), University of California San Francisco; Pediatric Multiple Sclerosis Center (G.S.A.), Loma Linda University Children's Hospital, CA; MS Comprehensive Care Center (L.K.), New York University Langone, NY; Pediatric Multiple Sclerosis and Related Disorders Program (L.B., M. Gorman), Boston Children's Hospital, MA; Division of Pediatric Neurology (M.C.), University of Utah Primary Children's Hospital, Salt Lake City; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Department of Radiology (M. Goyal), Washington University St. Louis, MO; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric-Onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Mayo Clinic Pediatric Multiple Sclerosis Center (M.R.), Mayo Clinic, Rochester, MN; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, State University of New York Buffalo; and Department of Neurosciences (J.G.), University of California San Diego
| | - Lisa F Barcellos
- From the Australian National University Medical School (P.S.), Centre for Research on Ageing, Health and Wellbeing (N.C.), and National Centre for Epidemiology and Population Health (R.L.), Australian National University, Canberra; Division of Epidemiology (L.F.B.), University of California Berkeley; Department of Pediatrics (S.R., C.C.), University of Utah School of Medicine, Salt Lake City; Pediatric Multiple Sclerosis Center (J.H.) and Department of Neurology (E.W.), University of California San Francisco; Pediatric Multiple Sclerosis Center (G.S.A.), Loma Linda University Children's Hospital, CA; MS Comprehensive Care Center (L.K.), New York University Langone, NY; Pediatric Multiple Sclerosis and Related Disorders Program (L.B., M. Gorman), Boston Children's Hospital, MA; Division of Pediatric Neurology (M.C.), University of Utah Primary Children's Hospital, Salt Lake City; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Department of Radiology (M. Goyal), Washington University St. Louis, MO; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric-Onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Mayo Clinic Pediatric Multiple Sclerosis Center (M.R.), Mayo Clinic, Rochester, MN; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, State University of New York Buffalo; and Department of Neurosciences (J.G.), University of California San Diego
| | - Shelly Roalstad
- From the Australian National University Medical School (P.S.), Centre for Research on Ageing, Health and Wellbeing (N.C.), and National Centre for Epidemiology and Population Health (R.L.), Australian National University, Canberra; Division of Epidemiology (L.F.B.), University of California Berkeley; Department of Pediatrics (S.R., C.C.), University of Utah School of Medicine, Salt Lake City; Pediatric Multiple Sclerosis Center (J.H.) and Department of Neurology (E.W.), University of California San Francisco; Pediatric Multiple Sclerosis Center (G.S.A.), Loma Linda University Children's Hospital, CA; MS Comprehensive Care Center (L.K.), New York University Langone, NY; Pediatric Multiple Sclerosis and Related Disorders Program (L.B., M. Gorman), Boston Children's Hospital, MA; Division of Pediatric Neurology (M.C.), University of Utah Primary Children's Hospital, Salt Lake City; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Department of Radiology (M. Goyal), Washington University St. Louis, MO; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric-Onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Mayo Clinic Pediatric Multiple Sclerosis Center (M.R.), Mayo Clinic, Rochester, MN; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, State University of New York Buffalo; and Department of Neurosciences (J.G.), University of California San Diego
| | - Charles Casper
- From the Australian National University Medical School (P.S.), Centre for Research on Ageing, Health and Wellbeing (N.C.), and National Centre for Epidemiology and Population Health (R.L.), Australian National University, Canberra; Division of Epidemiology (L.F.B.), University of California Berkeley; Department of Pediatrics (S.R., C.C.), University of Utah School of Medicine, Salt Lake City; Pediatric Multiple Sclerosis Center (J.H.) and Department of Neurology (E.W.), University of California San Francisco; Pediatric Multiple Sclerosis Center (G.S.A.), Loma Linda University Children's Hospital, CA; MS Comprehensive Care Center (L.K.), New York University Langone, NY; Pediatric Multiple Sclerosis and Related Disorders Program (L.B., M. Gorman), Boston Children's Hospital, MA; Division of Pediatric Neurology (M.C.), University of Utah Primary Children's Hospital, Salt Lake City; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Department of Radiology (M. Goyal), Washington University St. Louis, MO; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric-Onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Mayo Clinic Pediatric Multiple Sclerosis Center (M.R.), Mayo Clinic, Rochester, MN; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, State University of New York Buffalo; and Department of Neurosciences (J.G.), University of California San Diego
| | - Janace Hart
- From the Australian National University Medical School (P.S.), Centre for Research on Ageing, Health and Wellbeing (N.C.), and National Centre for Epidemiology and Population Health (R.L.), Australian National University, Canberra; Division of Epidemiology (L.F.B.), University of California Berkeley; Department of Pediatrics (S.R., C.C.), University of Utah School of Medicine, Salt Lake City; Pediatric Multiple Sclerosis Center (J.H.) and Department of Neurology (E.W.), University of California San Francisco; Pediatric Multiple Sclerosis Center (G.S.A.), Loma Linda University Children's Hospital, CA; MS Comprehensive Care Center (L.K.), New York University Langone, NY; Pediatric Multiple Sclerosis and Related Disorders Program (L.B., M. Gorman), Boston Children's Hospital, MA; Division of Pediatric Neurology (M.C.), University of Utah Primary Children's Hospital, Salt Lake City; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Department of Radiology (M. Goyal), Washington University St. Louis, MO; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric-Onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Mayo Clinic Pediatric Multiple Sclerosis Center (M.R.), Mayo Clinic, Rochester, MN; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, State University of New York Buffalo; and Department of Neurosciences (J.G.), University of California San Diego
| | - Gregory S Aaen
- From the Australian National University Medical School (P.S.), Centre for Research on Ageing, Health and Wellbeing (N.C.), and National Centre for Epidemiology and Population Health (R.L.), Australian National University, Canberra; Division of Epidemiology (L.F.B.), University of California Berkeley; Department of Pediatrics (S.R., C.C.), University of Utah School of Medicine, Salt Lake City; Pediatric Multiple Sclerosis Center (J.H.) and Department of Neurology (E.W.), University of California San Francisco; Pediatric Multiple Sclerosis Center (G.S.A.), Loma Linda University Children's Hospital, CA; MS Comprehensive Care Center (L.K.), New York University Langone, NY; Pediatric Multiple Sclerosis and Related Disorders Program (L.B., M. Gorman), Boston Children's Hospital, MA; Division of Pediatric Neurology (M.C.), University of Utah Primary Children's Hospital, Salt Lake City; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Department of Radiology (M. Goyal), Washington University St. Louis, MO; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric-Onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Mayo Clinic Pediatric Multiple Sclerosis Center (M.R.), Mayo Clinic, Rochester, MN; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, State University of New York Buffalo; and Department of Neurosciences (J.G.), University of California San Diego
| | - Lauren Krupp
- From the Australian National University Medical School (P.S.), Centre for Research on Ageing, Health and Wellbeing (N.C.), and National Centre for Epidemiology and Population Health (R.L.), Australian National University, Canberra; Division of Epidemiology (L.F.B.), University of California Berkeley; Department of Pediatrics (S.R., C.C.), University of Utah School of Medicine, Salt Lake City; Pediatric Multiple Sclerosis Center (J.H.) and Department of Neurology (E.W.), University of California San Francisco; Pediatric Multiple Sclerosis Center (G.S.A.), Loma Linda University Children's Hospital, CA; MS Comprehensive Care Center (L.K.), New York University Langone, NY; Pediatric Multiple Sclerosis and Related Disorders Program (L.B., M. Gorman), Boston Children's Hospital, MA; Division of Pediatric Neurology (M.C.), University of Utah Primary Children's Hospital, Salt Lake City; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Department of Radiology (M. Goyal), Washington University St. Louis, MO; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric-Onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Mayo Clinic Pediatric Multiple Sclerosis Center (M.R.), Mayo Clinic, Rochester, MN; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, State University of New York Buffalo; and Department of Neurosciences (J.G.), University of California San Diego
| | - Leslie Benson
- From the Australian National University Medical School (P.S.), Centre for Research on Ageing, Health and Wellbeing (N.C.), and National Centre for Epidemiology and Population Health (R.L.), Australian National University, Canberra; Division of Epidemiology (L.F.B.), University of California Berkeley; Department of Pediatrics (S.R., C.C.), University of Utah School of Medicine, Salt Lake City; Pediatric Multiple Sclerosis Center (J.H.) and Department of Neurology (E.W.), University of California San Francisco; Pediatric Multiple Sclerosis Center (G.S.A.), Loma Linda University Children's Hospital, CA; MS Comprehensive Care Center (L.K.), New York University Langone, NY; Pediatric Multiple Sclerosis and Related Disorders Program (L.B., M. Gorman), Boston Children's Hospital, MA; Division of Pediatric Neurology (M.C.), University of Utah Primary Children's Hospital, Salt Lake City; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Department of Radiology (M. Goyal), Washington University St. Louis, MO; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric-Onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Mayo Clinic Pediatric Multiple Sclerosis Center (M.R.), Mayo Clinic, Rochester, MN; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, State University of New York Buffalo; and Department of Neurosciences (J.G.), University of California San Diego
| | - Mark Gorman
- From the Australian National University Medical School (P.S.), Centre for Research on Ageing, Health and Wellbeing (N.C.), and National Centre for Epidemiology and Population Health (R.L.), Australian National University, Canberra; Division of Epidemiology (L.F.B.), University of California Berkeley; Department of Pediatrics (S.R., C.C.), University of Utah School of Medicine, Salt Lake City; Pediatric Multiple Sclerosis Center (J.H.) and Department of Neurology (E.W.), University of California San Francisco; Pediatric Multiple Sclerosis Center (G.S.A.), Loma Linda University Children's Hospital, CA; MS Comprehensive Care Center (L.K.), New York University Langone, NY; Pediatric Multiple Sclerosis and Related Disorders Program (L.B., M. Gorman), Boston Children's Hospital, MA; Division of Pediatric Neurology (M.C.), University of Utah Primary Children's Hospital, Salt Lake City; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Department of Radiology (M. Goyal), Washington University St. Louis, MO; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric-Onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Mayo Clinic Pediatric Multiple Sclerosis Center (M.R.), Mayo Clinic, Rochester, MN; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, State University of New York Buffalo; and Department of Neurosciences (J.G.), University of California San Diego
| | - Meghan Candee
- From the Australian National University Medical School (P.S.), Centre for Research on Ageing, Health and Wellbeing (N.C.), and National Centre for Epidemiology and Population Health (R.L.), Australian National University, Canberra; Division of Epidemiology (L.F.B.), University of California Berkeley; Department of Pediatrics (S.R., C.C.), University of Utah School of Medicine, Salt Lake City; Pediatric Multiple Sclerosis Center (J.H.) and Department of Neurology (E.W.), University of California San Francisco; Pediatric Multiple Sclerosis Center (G.S.A.), Loma Linda University Children's Hospital, CA; MS Comprehensive Care Center (L.K.), New York University Langone, NY; Pediatric Multiple Sclerosis and Related Disorders Program (L.B., M. Gorman), Boston Children's Hospital, MA; Division of Pediatric Neurology (M.C.), University of Utah Primary Children's Hospital, Salt Lake City; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Department of Radiology (M. Goyal), Washington University St. Louis, MO; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric-Onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Mayo Clinic Pediatric Multiple Sclerosis Center (M.R.), Mayo Clinic, Rochester, MN; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, State University of New York Buffalo; and Department of Neurosciences (J.G.), University of California San Diego
| | - Tanuja Chitnis
- From the Australian National University Medical School (P.S.), Centre for Research on Ageing, Health and Wellbeing (N.C.), and National Centre for Epidemiology and Population Health (R.L.), Australian National University, Canberra; Division of Epidemiology (L.F.B.), University of California Berkeley; Department of Pediatrics (S.R., C.C.), University of Utah School of Medicine, Salt Lake City; Pediatric Multiple Sclerosis Center (J.H.) and Department of Neurology (E.W.), University of California San Francisco; Pediatric Multiple Sclerosis Center (G.S.A.), Loma Linda University Children's Hospital, CA; MS Comprehensive Care Center (L.K.), New York University Langone, NY; Pediatric Multiple Sclerosis and Related Disorders Program (L.B., M. Gorman), Boston Children's Hospital, MA; Division of Pediatric Neurology (M.C.), University of Utah Primary Children's Hospital, Salt Lake City; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Department of Radiology (M. Goyal), Washington University St. Louis, MO; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric-Onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Mayo Clinic Pediatric Multiple Sclerosis Center (M.R.), Mayo Clinic, Rochester, MN; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, State University of New York Buffalo; and Department of Neurosciences (J.G.), University of California San Diego
| | - Manu Goyal
- From the Australian National University Medical School (P.S.), Centre for Research on Ageing, Health and Wellbeing (N.C.), and National Centre for Epidemiology and Population Health (R.L.), Australian National University, Canberra; Division of Epidemiology (L.F.B.), University of California Berkeley; Department of Pediatrics (S.R., C.C.), University of Utah School of Medicine, Salt Lake City; Pediatric Multiple Sclerosis Center (J.H.) and Department of Neurology (E.W.), University of California San Francisco; Pediatric Multiple Sclerosis Center (G.S.A.), Loma Linda University Children's Hospital, CA; MS Comprehensive Care Center (L.K.), New York University Langone, NY; Pediatric Multiple Sclerosis and Related Disorders Program (L.B., M. Gorman), Boston Children's Hospital, MA; Division of Pediatric Neurology (M.C.), University of Utah Primary Children's Hospital, Salt Lake City; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Department of Radiology (M. Goyal), Washington University St. Louis, MO; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric-Onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Mayo Clinic Pediatric Multiple Sclerosis Center (M.R.), Mayo Clinic, Rochester, MN; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, State University of New York Buffalo; and Department of Neurosciences (J.G.), University of California San Diego
| | - Benjamin Greenberg
- From the Australian National University Medical School (P.S.), Centre for Research on Ageing, Health and Wellbeing (N.C.), and National Centre for Epidemiology and Population Health (R.L.), Australian National University, Canberra; Division of Epidemiology (L.F.B.), University of California Berkeley; Department of Pediatrics (S.R., C.C.), University of Utah School of Medicine, Salt Lake City; Pediatric Multiple Sclerosis Center (J.H.) and Department of Neurology (E.W.), University of California San Francisco; Pediatric Multiple Sclerosis Center (G.S.A.), Loma Linda University Children's Hospital, CA; MS Comprehensive Care Center (L.K.), New York University Langone, NY; Pediatric Multiple Sclerosis and Related Disorders Program (L.B., M. Gorman), Boston Children's Hospital, MA; Division of Pediatric Neurology (M.C.), University of Utah Primary Children's Hospital, Salt Lake City; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Department of Radiology (M. Goyal), Washington University St. Louis, MO; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric-Onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Mayo Clinic Pediatric Multiple Sclerosis Center (M.R.), Mayo Clinic, Rochester, MN; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, State University of New York Buffalo; and Department of Neurosciences (J.G.), University of California San Diego
| | - Soe Mar
- From the Australian National University Medical School (P.S.), Centre for Research on Ageing, Health and Wellbeing (N.C.), and National Centre for Epidemiology and Population Health (R.L.), Australian National University, Canberra; Division of Epidemiology (L.F.B.), University of California Berkeley; Department of Pediatrics (S.R., C.C.), University of Utah School of Medicine, Salt Lake City; Pediatric Multiple Sclerosis Center (J.H.) and Department of Neurology (E.W.), University of California San Francisco; Pediatric Multiple Sclerosis Center (G.S.A.), Loma Linda University Children's Hospital, CA; MS Comprehensive Care Center (L.K.), New York University Langone, NY; Pediatric Multiple Sclerosis and Related Disorders Program (L.B., M. Gorman), Boston Children's Hospital, MA; Division of Pediatric Neurology (M.C.), University of Utah Primary Children's Hospital, Salt Lake City; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Department of Radiology (M. Goyal), Washington University St. Louis, MO; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric-Onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Mayo Clinic Pediatric Multiple Sclerosis Center (M.R.), Mayo Clinic, Rochester, MN; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, State University of New York Buffalo; and Department of Neurosciences (J.G.), University of California San Diego
| | - Moses Rodriguez
- From the Australian National University Medical School (P.S.), Centre for Research on Ageing, Health and Wellbeing (N.C.), and National Centre for Epidemiology and Population Health (R.L.), Australian National University, Canberra; Division of Epidemiology (L.F.B.), University of California Berkeley; Department of Pediatrics (S.R., C.C.), University of Utah School of Medicine, Salt Lake City; Pediatric Multiple Sclerosis Center (J.H.) and Department of Neurology (E.W.), University of California San Francisco; Pediatric Multiple Sclerosis Center (G.S.A.), Loma Linda University Children's Hospital, CA; MS Comprehensive Care Center (L.K.), New York University Langone, NY; Pediatric Multiple Sclerosis and Related Disorders Program (L.B., M. Gorman), Boston Children's Hospital, MA; Division of Pediatric Neurology (M.C.), University of Utah Primary Children's Hospital, Salt Lake City; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Department of Radiology (M. Goyal), Washington University St. Louis, MO; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric-Onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Mayo Clinic Pediatric Multiple Sclerosis Center (M.R.), Mayo Clinic, Rochester, MN; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, State University of New York Buffalo; and Department of Neurosciences (J.G.), University of California San Diego
| | - Jennifer Rubin
- From the Australian National University Medical School (P.S.), Centre for Research on Ageing, Health and Wellbeing (N.C.), and National Centre for Epidemiology and Population Health (R.L.), Australian National University, Canberra; Division of Epidemiology (L.F.B.), University of California Berkeley; Department of Pediatrics (S.R., C.C.), University of Utah School of Medicine, Salt Lake City; Pediatric Multiple Sclerosis Center (J.H.) and Department of Neurology (E.W.), University of California San Francisco; Pediatric Multiple Sclerosis Center (G.S.A.), Loma Linda University Children's Hospital, CA; MS Comprehensive Care Center (L.K.), New York University Langone, NY; Pediatric Multiple Sclerosis and Related Disorders Program (L.B., M. Gorman), Boston Children's Hospital, MA; Division of Pediatric Neurology (M.C.), University of Utah Primary Children's Hospital, Salt Lake City; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Department of Radiology (M. Goyal), Washington University St. Louis, MO; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric-Onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Mayo Clinic Pediatric Multiple Sclerosis Center (M.R.), Mayo Clinic, Rochester, MN; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, State University of New York Buffalo; and Department of Neurosciences (J.G.), University of California San Diego
| | - Teri Schreiner
- From the Australian National University Medical School (P.S.), Centre for Research on Ageing, Health and Wellbeing (N.C.), and National Centre for Epidemiology and Population Health (R.L.), Australian National University, Canberra; Division of Epidemiology (L.F.B.), University of California Berkeley; Department of Pediatrics (S.R., C.C.), University of Utah School of Medicine, Salt Lake City; Pediatric Multiple Sclerosis Center (J.H.) and Department of Neurology (E.W.), University of California San Francisco; Pediatric Multiple Sclerosis Center (G.S.A.), Loma Linda University Children's Hospital, CA; MS Comprehensive Care Center (L.K.), New York University Langone, NY; Pediatric Multiple Sclerosis and Related Disorders Program (L.B., M. Gorman), Boston Children's Hospital, MA; Division of Pediatric Neurology (M.C.), University of Utah Primary Children's Hospital, Salt Lake City; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Department of Radiology (M. Goyal), Washington University St. Louis, MO; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric-Onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Mayo Clinic Pediatric Multiple Sclerosis Center (M.R.), Mayo Clinic, Rochester, MN; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, State University of New York Buffalo; and Department of Neurosciences (J.G.), University of California San Diego
| | - Amy Waldman
- From the Australian National University Medical School (P.S.), Centre for Research on Ageing, Health and Wellbeing (N.C.), and National Centre for Epidemiology and Population Health (R.L.), Australian National University, Canberra; Division of Epidemiology (L.F.B.), University of California Berkeley; Department of Pediatrics (S.R., C.C.), University of Utah School of Medicine, Salt Lake City; Pediatric Multiple Sclerosis Center (J.H.) and Department of Neurology (E.W.), University of California San Francisco; Pediatric Multiple Sclerosis Center (G.S.A.), Loma Linda University Children's Hospital, CA; MS Comprehensive Care Center (L.K.), New York University Langone, NY; Pediatric Multiple Sclerosis and Related Disorders Program (L.B., M. Gorman), Boston Children's Hospital, MA; Division of Pediatric Neurology (M.C.), University of Utah Primary Children's Hospital, Salt Lake City; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Department of Radiology (M. Goyal), Washington University St. Louis, MO; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric-Onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Mayo Clinic Pediatric Multiple Sclerosis Center (M.R.), Mayo Clinic, Rochester, MN; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, State University of New York Buffalo; and Department of Neurosciences (J.G.), University of California San Diego
| | - Bianca Weinstock-Guttman
- From the Australian National University Medical School (P.S.), Centre for Research on Ageing, Health and Wellbeing (N.C.), and National Centre for Epidemiology and Population Health (R.L.), Australian National University, Canberra; Division of Epidemiology (L.F.B.), University of California Berkeley; Department of Pediatrics (S.R., C.C.), University of Utah School of Medicine, Salt Lake City; Pediatric Multiple Sclerosis Center (J.H.) and Department of Neurology (E.W.), University of California San Francisco; Pediatric Multiple Sclerosis Center (G.S.A.), Loma Linda University Children's Hospital, CA; MS Comprehensive Care Center (L.K.), New York University Langone, NY; Pediatric Multiple Sclerosis and Related Disorders Program (L.B., M. Gorman), Boston Children's Hospital, MA; Division of Pediatric Neurology (M.C.), University of Utah Primary Children's Hospital, Salt Lake City; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Department of Radiology (M. Goyal), Washington University St. Louis, MO; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric-Onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Mayo Clinic Pediatric Multiple Sclerosis Center (M.R.), Mayo Clinic, Rochester, MN; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, State University of New York Buffalo; and Department of Neurosciences (J.G.), University of California San Diego
| | - Jennifer Graves
- From the Australian National University Medical School (P.S.), Centre for Research on Ageing, Health and Wellbeing (N.C.), and National Centre for Epidemiology and Population Health (R.L.), Australian National University, Canberra; Division of Epidemiology (L.F.B.), University of California Berkeley; Department of Pediatrics (S.R., C.C.), University of Utah School of Medicine, Salt Lake City; Pediatric Multiple Sclerosis Center (J.H.) and Department of Neurology (E.W.), University of California San Francisco; Pediatric Multiple Sclerosis Center (G.S.A.), Loma Linda University Children's Hospital, CA; MS Comprehensive Care Center (L.K.), New York University Langone, NY; Pediatric Multiple Sclerosis and Related Disorders Program (L.B., M. Gorman), Boston Children's Hospital, MA; Division of Pediatric Neurology (M.C.), University of Utah Primary Children's Hospital, Salt Lake City; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Department of Radiology (M. Goyal), Washington University St. Louis, MO; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric-Onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Mayo Clinic Pediatric Multiple Sclerosis Center (M.R.), Mayo Clinic, Rochester, MN; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, State University of New York Buffalo; and Department of Neurosciences (J.G.), University of California San Diego
| | - Emmanuelle Waubant
- From the Australian National University Medical School (P.S.), Centre for Research on Ageing, Health and Wellbeing (N.C.), and National Centre for Epidemiology and Population Health (R.L.), Australian National University, Canberra; Division of Epidemiology (L.F.B.), University of California Berkeley; Department of Pediatrics (S.R., C.C.), University of Utah School of Medicine, Salt Lake City; Pediatric Multiple Sclerosis Center (J.H.) and Department of Neurology (E.W.), University of California San Francisco; Pediatric Multiple Sclerosis Center (G.S.A.), Loma Linda University Children's Hospital, CA; MS Comprehensive Care Center (L.K.), New York University Langone, NY; Pediatric Multiple Sclerosis and Related Disorders Program (L.B., M. Gorman), Boston Children's Hospital, MA; Division of Pediatric Neurology (M.C.), University of Utah Primary Children's Hospital, Salt Lake City; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Department of Radiology (M. Goyal), Washington University St. Louis, MO; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric-Onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Mayo Clinic Pediatric Multiple Sclerosis Center (M.R.), Mayo Clinic, Rochester, MN; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, State University of New York Buffalo; and Department of Neurosciences (J.G.), University of California San Diego.
| | - Robyn Lucas
- From the Australian National University Medical School (P.S.), Centre for Research on Ageing, Health and Wellbeing (N.C.), and National Centre for Epidemiology and Population Health (R.L.), Australian National University, Canberra; Division of Epidemiology (L.F.B.), University of California Berkeley; Department of Pediatrics (S.R., C.C.), University of Utah School of Medicine, Salt Lake City; Pediatric Multiple Sclerosis Center (J.H.) and Department of Neurology (E.W.), University of California San Francisco; Pediatric Multiple Sclerosis Center (G.S.A.), Loma Linda University Children's Hospital, CA; MS Comprehensive Care Center (L.K.), New York University Langone, NY; Pediatric Multiple Sclerosis and Related Disorders Program (L.B., M. Gorman), Boston Children's Hospital, MA; Division of Pediatric Neurology (M.C.), University of Utah Primary Children's Hospital, Salt Lake City; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Department of Radiology (M. Goyal), Washington University St. Louis, MO; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric-Onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Mayo Clinic Pediatric Multiple Sclerosis Center (M.R.), Mayo Clinic, Rochester, MN; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, State University of New York Buffalo; and Department of Neurosciences (J.G.), University of California San Diego
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10
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Gavazzi F, Adang L, Waldman A, Jan AK, Liu G, Lorch SA, DeMauro SB, Shults J, Pierce SR, Ballance E, Kornafel T, Harrington A, Glanzman AM, Vanderver A. Reliability of the Telemedicine Application of the Gross Motor Function Measure-88 in Patients With Leukodystrophy. Pediatr Neurol 2021; 125:34-39. [PMID: 34624609 PMCID: PMC8629609 DOI: 10.1016/j.pediatrneurol.2021.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/16/2021] [Accepted: 09/18/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Leukodystrophies are a rare class of disorders characterized by severe neuromotor disability. There is a strong need for research regarding the functional status of people with leukodystrophy which is limited by the need for in-person assessments of mobility. The purpose of this study is to assess the reliability of the Gross Motor Function Measure-88 (GMFM-88) using telemedicine compared with standard in-person assessments in patients with leukodystrophy. METHODS A total of 21 subjects with a diagnosis of leukodystrophy (age range = 1.79-52.82 years) were evaluated by in-person and by telemedicine evaluations with the GMFM-88 by physical therapists. Inter-rater reliability was assessed through evaluation of the same subject by two independent raters within a three-week period (n = 10 encounters), and intrarater reliability was assessed through blinded rescoring of video-recorded assessments after a one-week time interval (n = 6 encounters). RESULTS Remote assessments were performed by caregivers in all 21 subjects using resources found in the home with remote guidance. There was agreement between all paired in-person and remote measurements (Lin's concordance correlation ≥0.995). The Bland-Altman analysis indicated that the paired differences were within ±5%. Intrarater and inter-rater reliability demonstrated an intraclass correlation coefficient of >0.90. CONCLUSIONS These results support that remote application of the GMFM-88 is a feasible and reliable approach to assess individuals with leukodystrophy. Telemedicine application of outcome measures may be of particular value in rare diseases and those with severe neurologic disability that impacts the ability to travel.
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Affiliation(s)
- Francesco Gavazzi
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.
| | - Laura Adang
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Amy Waldman
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Amanda K. Jan
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Geraldine Liu
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Scott A. Lorch
- Department of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Sara B. DeMauro
- Department of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Justine Shults
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Samuel R. Pierce
- Departmen of Physical Therapy, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Elizabeth Ballance
- Departmen of Physical Therapy, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Tracy Kornafel
- Departmen of Physical Therapy, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Ann Harrington
- Departmen of Physical Therapy, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Allan M. Glanzman
- Departmen of Physical Therapy, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Adeline Vanderver
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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11
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Horton MK, McCauley K, Fadrosh D, Fujimura K, Graves J, Ness J, Wheeler Y, Gorman MP, Benson LA, Weinstock‐Guttman B, Waldman A, Rodriguez M, Tillema J, Krupp L, Belman A, Mar S, Rensel M, Chitnis T, Casper TC, Rose J, Hart J, Shao X, Tremlett H, Lynch SV, Barcellos LF, Waubant E. Gut microbiome is associated with multiple sclerosis activity in children. Ann Clin Transl Neurol 2021; 8:1867-1883. [PMID: 34409759 PMCID: PMC8419410 DOI: 10.1002/acn3.51441] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To identify features of the gut microbiome associated with multiple sclerosis activity over time. METHODS We used 16S ribosomal RNA sequencing from stool of 55 recently diagnosed pediatric-onset multiple sclerosis patients. Microbiome features included the abundance of individual microbes and networks identified from weighted genetic correlation network analyses. Prentice-Williams-Peterson Cox proportional hazards models estimated the associations between features and three disease activity outcomes: clinical relapses and both new/enlarging T2 lesions and new gadolinium-enhancing lesions on brain MRI. Analyses were adjusted for age, sex, and disease-modifying therapies. RESULTS Participants were followed, on average, 2.1 years. Five microbes were nominally associated with all three disease activity outcomes after multiple testing correction. These included butyrate producers Odoribacter (relapse hazard ratio = 0.46, 95% confidence interval: 0.24, 0.88) and Butyricicoccus (relapse hazard ratio = 0.49, 95% confidence interval: 0.28, 0.88). Two networks of co-occurring gut microbes were significantly associated with a higher hazard of both MRI outcomes (gadolinium-enhancing lesion hazard ratios (95% confidence intervals) for Modules 32 and 33 were 1.29 (1.08, 1.54) and 1.42 (1.18, 1.71), respectively; T2 lesion hazard ratios (95% confidence intervals) for Modules 32 and 33 were 1.34 (1.15, 1.56) and 1.41 (1.21, 1.64), respectively). Metagenomic predictions of these networks demonstrated enrichment for amino acid biosynthesis pathways. INTERPRETATION Both individual and networks of gut microbes were associated with longitudinal multiple sclerosis activity. Known functions and metagenomic predictions of these microbes suggest the important role of butyrate and amino acid biosynthesis pathways. This provides strong support for future development of personalized microbiome interventions to modify multiple sclerosis disease activity.
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Affiliation(s)
- Mary K. Horton
- Division of EpidemiologyUniversity of California, BerkeleyBerkeleyCaliforniaUSA
| | - Kathryn McCauley
- Department of Medicine‐ GastroenterologyUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Douglas Fadrosh
- Department of Medicine‐ GastroenterologyUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Kei Fujimura
- Department of Medicine‐ GastroenterologyUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Jennifer Graves
- Department of NeurosciencesUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Jayne Ness
- Division of Pediatric NeurologyUniversity of AlabamaBirminghamAlabamaUSA
| | - Yolanda Wheeler
- Division of Pediatric NeurologyUniversity of AlabamaBirminghamAlabamaUSA
| | - Mark P. Gorman
- Department of NeurologyBoston Children’s HospitalBostonMassachusettsUSA
| | - Leslie A. Benson
- Department of NeurologyBoston Children’s HospitalBostonMassachusettsUSA
| | | | - Amy Waldman
- Department of NeurologyChildren’s Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | | | | | - Lauren Krupp
- Pediatric Multiple Sclerosis CenterNew York University Langone Medical CenterNew YorkNew YorkUSA
| | - Anita Belman
- Pediatric Multiple Sclerosis CenterNew York University Langone Medical CenterNew YorkNew YorkUSA
| | - Soe Mar
- Department of NeurologyWashington University in St. LouisSt. LouisMissouriUSA
| | - Mary Rensel
- Department of NeurologyCleveland ClinicClevelandOhioUSA
| | - Tanuja Chitnis
- Division of Child NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | | | - John Rose
- School of MedicineUniversity of Utah SchoolSalt Lake CityUtahUSA
| | - Janace Hart
- Department of NeurologyUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Xiaorong Shao
- Division of EpidemiologyUniversity of California, BerkeleyBerkeleyCaliforniaUSA
| | - Helen Tremlett
- Department of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Susan V. Lynch
- Department of Medicine‐ GastroenterologyUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Lisa F. Barcellos
- Division of EpidemiologyUniversity of California, BerkeleyBerkeleyCaliforniaUSA
| | - Emmanuelle Waubant
- Department of NeurologyUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
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12
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Sollee J, Waldman A. Teaching NeuroImages: Dorsal Medullary Lesions in Juvenile-Onset Alexander Disease. Neurology 2021; 97:e2050-e2051. [PMID: 34158385 DOI: 10.1212/wnl.0000000000012411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- John Sollee
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA; .,Warren Alpert Medical School of Brown University, Providence, RI
| | - Amy Waldman
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA.,Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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13
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Babbush K, Waldman A, Ghias M, Nosrati A, Pacific K, Lee D, Cohen S. 449 Characterizing a cohort of pediatric patients with hidradenitis suppurativa. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Graves JS, Barcellos LF, Krupp L, Belman A, Shao X, Quach H, Hart J, Chitnis T, Weinstock-Guttman B, Aaen G, Benson L, Gorman M, Greenberg B, Lotze T, Soe M, Ness J, Rodriguez M, Rose J, Schreiner T, Tillema JM, Waldman A, Casper TC, Waubant E. Vitamin D genes influence MS relapses in children. Mult Scler 2020; 26:894-901. [PMID: 31081484 PMCID: PMC6851448 DOI: 10.1177/1352458519845842] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The aim of this study was to determine whether a vitamin D genetic risk score (vitDGRS) is associated with 25-hydroxyvitamin D (25(OH)D) level and multiple sclerosis (MS) relapses in children. METHODS DNA samples were typed for single nucleotide polymorphisms (SNPs) from four genes previously identified to be associated with 25(OH)D levels. SNPs with strong associations with 25(OH)D after multiple comparison correction were used to create a genetic risk score (vitDGRS). Cox regression models tested associations of vitDGRS with relapse hazard. RESULTS Two independent SNPs within or near GC and NADSYN1/DHCR7 genes were strongly associated with 25(OH)D levels in the discovery cohort (n = 182) after Bonferroni correction. The vitDGRS of these SNPs explained 4.5% of the variance of 25(OH)D level after adjustment for genetic ancestry. Having the highest versus lowest vitDGRS was associated with 11 ng/mL lower 25(OH)D level (95% confidence interval (CI) = -17.5, -4.5, p = 0.001) in the discovery cohort. Adjusting for ancestry, sex, disease-modifying therapy (DMT), and HLA-DRB1*15 carrier status, the highest versus lowest vitDGRS was associated with 2.6-fold (95% CI = 1.37, 5.03, p = 0.004) and 2.0-fold (95% CI = 0.75, 5.20, p = 0.16) higher relapse hazard in the discovery and replication cohorts, respectively. CONCLUSION The vitDGRS identifies children at greater risk of relapse. These findings support a causal role for vitamin D in MS course.
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Affiliation(s)
- Jennifer S Graves
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Lisa F Barcellos
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Lauren Krupp
- Pediatric Multiple Sclerosis Center, New York University Langone Medical Center, New York, NY, USA
| | | | - Xiaorong Shao
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Hong Quach
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Janace Hart
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Tanuja Chitnis
- Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital for Children, Boston, MA, USA
| | | | - Gregory Aaen
- Pediatric Multiple Sclerosis Center, Loma Linda University Children's Hospital, San Bernardino, CA, USA
| | - Leslie Benson
- Pediatric Multiple Sclerosis and Related Disorders Program, Boston Children's Hospital, Boston, MA, USA
| | - Mark Gorman
- Pediatric Multiple Sclerosis and Related Disorders Program, Boston Children's Hospital, Boston, MA, USA
| | | | - Timothy Lotze
- The Blue Bird Circle Clinic for Multiple Sclerosis, Texas Children's Hospital, Houston, TX, USA
| | - Mar Soe
- Pediatric MS & Demyelinating Disease Center, Washington University, St. Louis, MI, USA
| | - Jayne Ness
- Center for Pediatric-Onset Demyelinating Disease, Children's of Alabama, Birmingham, AL, USA
| | - Moses Rodriguez
- Pediatric Multiple Sclerosis Center, Mayo Clinic, Rochester, MA, USA
| | - John Rose
- Department of Neurology, The University of Utah, Salt Lake City, UT, USA
| | - Teri Schreiner
- Rocky Mountain MS Center, University of Colorado, Denver, Denver, CO, USA
| | | | - Amy Waldman
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - T Charles Casper
- Department of Pediatrics, The University of Utah, Salt Lake City, UT, USA
| | - Emmanuelle Waubant
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
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15
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Helman G, Takanohashi A, Hagemann TL, Perng MD, Walkiewicz M, Woidill S, Sase S, Cross Z, Du Y, Zhao L, Waldman A, Haake BC, Fatemi A, Brenner M, Sherbini O, Messing A, Vanderver A, Simons C. Type II Alexander disease caused by splicing errors and aberrant overexpression of an uncharacterized GFAP isoform. Hum Mutat 2020; 41:1131-1137. [PMID: 32126152 PMCID: PMC7491703 DOI: 10.1002/humu.24008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/07/2020] [Accepted: 02/25/2020] [Indexed: 12/15/2022]
Abstract
Alexander disease results from gain-of-function mutations in the gene encoding glial fibrillary acidic protein (GFAP). At least eight GFAP isoforms have been described, however, the predominant alpha isoform accounts for ∼90% of GFAP protein. We describe exonic variants identified in three unrelated families with Type II Alexander disease that alter the splicing of GFAP pre-messenger RNA (mRNA) and result in the upregulation of a previously uncharacterized GFAP lambda isoform (NM_001363846.1). Affected members of Family 1 and Family 2 shared the same missense variant, NM_001363846.1:c.1289G>A;p.(Arg430His) while in Family 3 we identified a synonymous variant in the adjacent nucleotide, NM_001363846.1:c.1290C>A;p.(Arg430Arg). Using RNA and protein analysis of brain autopsy samples, and a mini-gene splicing reporter assay, we demonstrate both variants result in the upregulation of the lambda isoform. Our approach demonstrates the importance of characterizing the effect of GFAP variants on mRNA splicing to inform future pathophysiologic and therapeutic study for Alexander disease.
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Affiliation(s)
- Guy Helman
- Murdoch Children’s Research Institute, The Royal Children’s Hospital, Parkville, Melbourne, Australia,Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | - Asako Takanohashi
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Ming D. Perng
- Institute of Molecular Medicine, College of Life Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Marzena Walkiewicz
- Murdoch Children’s Research Institute, The Royal Children’s Hospital, Parkville, Melbourne, Australia
| | - Sarah Woidill
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sunetra Sase
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Zachary Cross
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Yangzhu Du
- Human Immunology Core, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ling Zhao
- Human Immunology Core, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amy Waldman
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Ali Fatemi
- Moser Center for Leukodystrophies, Kennedy Krieger Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Brenner
- Department of Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Omar Sherbini
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Albee Messing
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA,Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Adeline Vanderver
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Correspondence to: Adeline Vanderver: , Cas Simons:
| | - Cas Simons
- Murdoch Children’s Research Institute, The Royal Children’s Hospital, Parkville, Melbourne, Australia,Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia,Correspondence to: Adeline Vanderver: , Cas Simons:
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16
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Gaetz W, Rhodes E, Bloy L, Blaskey L, Jackel CR, Brodkin ES, Waldman A, Embick D, Hall S, Roberts TPL. Evaluating motor cortical oscillations and age-related change in autism spectrum disorder. Neuroimage 2019; 207:116349. [PMID: 31726253 DOI: 10.1016/j.neuroimage.2019.116349] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 11/07/2019] [Accepted: 11/09/2019] [Indexed: 12/11/2022] Open
Abstract
Autism spectrum disorder (ASD) is primarily characterized by impairments in social communication and the appearance of repetitive behaviors with restricted interests. Increasingly, evidence also points to a general deficit of motor tone and coordination in children and adults with ASD; yet the neural basis of motor functional impairment in ASD remains poorly characterized. In this study, we used magnetoencephalography (MEG) to (1) assess potential group differences between typically developing (TD) and ASD participants in motor cortical oscillatory activity observed on a simple button-press task and (2) to do so over a sufficiently broad age-range so as to capture age-dependent changes associated with development. Event-related desynchronization was evaluated in Mu (8-13 Hz) and Beta (15-30 Hz) frequency bands (Mu-ERD, Beta-ERD). In addition, post-movement Beta rebound (PMBR), and movement-related gamma (60-90 Hz) synchrony (MRGS) were also assessed in a cohort of 123 participants (63 typically developing (TD) and 59 with ASD) ranging in age from 8 to 24.9 years. We observed significant age-dependent linear trends in Beta-ERD and MRGS power with age for both TD and ASD groups; which did not differ significantly between groups. However, for PMBR, in addition to a significant effect of age, we also observed a significant reduction in PMBR power in the ASD group (p < 0.05). Post-hoc tests showed that this omnibus group difference was driven by the older cohort of children >13.2 years (p < 0.001) and this group difference was not observed when assessing PMBR activity for the younger PMBR groups (ages 8-13.2 years; p = 0.48). Moreover, for the older ASD cohort, hierarchical regression showed a significant relationship between PMBR activity and clinical scores of ASD severity (Social Responsiveness Scale (SRS T scores)), after regressing out the effect of age (p < 0.05). Our results show substantial age-dependent changes in motor cortical oscillations (Beta-ERD and MRGS) occur for both TD and ASD children and diverge only for PMBR, and most significantly for older adolescents and adults with ASD. While the functional significance of PMBR and reduced PMBR signaling remains to be fully elucidated, these results underscore the importance of considering age as a factor when assessing motor cortical oscillations and group differences in children with ASD.
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Affiliation(s)
- William Gaetz
- Lurie Family Foundations' MEG Imaging Center, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Edward Rhodes
- UK Dementia Research Institute, Imperial College London, London, UK
| | - Luke Bloy
- Lurie Family Foundations' MEG Imaging Center, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lisa Blaskey
- Lurie Family Foundations' MEG Imaging Center, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Carissa R Jackel
- Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, USA
| | - Edward S Brodkin
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Amy Waldman
- Division of Neurology, Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - David Embick
- Department of Linguistics, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen Hall
- Brain Research and Imaging Centre, University of Plymouth, Devon, UK
| | - Timothy P L Roberts
- Lurie Family Foundations' MEG Imaging Center, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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17
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Ipe TS, Raval JS, Fernando LP, Gokhale A, Jacquot C, Johnson AD, Kim HC, Monis GF, Mo YD, Morgan SM, Pagano MB, Pham HP, Sanford K, Schmidt AE, Schwartz J, Waldman A, Webb J, Winters JL, Wu Y, Yamada C, Wong ECC. Therapeutic plasma exchange for neuromyelitis optica spectrum disorder: A multicenter retrospective study by the ASFA neurologic diseases subcommittee. J Clin Apher 2019; 35:25-32. [DOI: 10.1002/jca.21754] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/04/2019] [Accepted: 09/18/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Tina S. Ipe
- Department of Pathology and Laboratory MedicineUniversity of Arkansas for Medical Sciences Little Rock Arkansas
- Department of Pathology and Genomic MedicineHouston Methodist Hospital Houston Texas
| | - Jay S. Raval
- Department of PathologyUniversity of New Mexico Albuquerque New Mexico
- Department of Pathology and Laboratory MedicineUniversity of North Carolina Chapel Hill North Carolina
| | - Leonor P. Fernando
- Department of Pathology and Laboratory MedicineUniversity of California, Davis Sacramento California
| | - Amit Gokhale
- Department of PathologyStony Brook University Stony Brook New York
| | - Cyril Jacquot
- Department of Laboratory Medicine and HematologyChildren's National Health System Washington District of Columbia
| | - Andrew D. Johnson
- Department of Laboratory Medicine and PathologyUniversity of Minnesota Minneapolis Minnesota
| | - Haewon C. Kim
- Department of Pediatrics and PathologyChildren's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Grace F. Monis
- Department of Pathology and Laboratory MedicineUniversity of California, Davis Sacramento California
| | - Yunchun D. Mo
- Department of Laboratory Medicine and HematologyChildren's National Health System Washington District of Columbia
| | | | - Monica B. Pagano
- Department of Laboratory MedicineUniversity of Washington Seattle Washington
| | - Huy P. Pham
- Department of PathologyUniversity of Southern California Los Angeles California
| | - Kimberly Sanford
- Department of PathologyVirginia Commonwealth University Richmond Virginia
| | - Amy E. Schmidt
- Department of Pathology and Laboratory MedicineUniversity of Rochester Medical Center Rochester New York
| | - Joseph Schwartz
- Department of Pathology and Cell BiologyColumbia University New York New York
| | - Amy Waldman
- Department of Pediatrics and PathologyChildren's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Jennifer Webb
- Department of Laboratory Medicine and HematologyChildren's National Health System Washington District of Columbia
| | - Jeffrey L. Winters
- Department of Laboratory Medicine and PathologyMayo Clinic Rochester Minnesota
| | - Yanyun Wu
- Bloodworks Northwest Seattle Washington
| | - Chisa Yamada
- Department of PathologyUniversity of Michigan Ann Arbor Michigan
| | - Edward C. C. Wong
- Department of CoagulationQuest Diagnostics Nichols Institute Chantilly Virginia
- Department of Pediatrics and PathologyGeorge Washington School of Medicine and Health Sciences and Children's National Hospital Washington District of Columbia
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18
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Maisel A, Waldman A, Reynolds K, Poon E, Alam M. LB1095 Differences in cosmetic motivations based on demographic variables. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.06.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Aaen G, Waltz M, Vargas W, Makhani N, Ness J, Harris Y, Casper TC, Benson L, Candee M, Chitnis T, Gorman M, Graves J, Greenberg B, MD TL, Mar S, Tillema JM, Rensel M, Rodriguez M, Rose J, Rubin J, Schreiner T, Waldman A, Weinstock-Guttman B, Belman A, Waubant E, Krupp L. Acquisition of Early Developmental Milestones and Need for Special Education Services in Pediatric Multiple Sclerosis. J Child Neurol 2019; 34:148-152. [PMID: 30556452 PMCID: PMC6579723 DOI: 10.1177/0883073818815041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Children with pediatric-onset multiple sclerosis and pediatric controls were enrolled across 16 pediatric multiple sclerosis centers in the United States and completed questionnaires that addressed time of first unaided walking and acquisition of 2-word phrases. A total of 467 (308 female) cases and 428 (209 female) controls were enrolled. Pediatric multiple sclerosis (n = 467) were not delayed in walking or using 2-word phrases compared to healthy controls (n = 428) (2.2% vs 5.7%, respectively). Children with disease onset before age 11 versus onset at 11 years or after were more likely to need an individualized education plan (P = .002), reading assistance (P = .0003), and math assistance (P = .001). Children with multiple sclerosis onset prior to age 18 are not delayed in meeting the 2 major early developmental milestones but do have a significantly increased use of special services or learning assistance at school. Further research will need to address whether other measures of development (eg, rate of language acquisition or fine motor skills) differ between pediatric multiple sclerosis and controls.
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Affiliation(s)
- Gregory Aaen
- Pediatric Multiple Sclerosis Center at Loma Linda University Children’s Hospital
| | | | - Wendy Vargas
- Pediatric Multiple Sclerosis Program, Columbia University Medical Center
| | - Naila Makhani
- Pediatric Multiple Sclerosis Program, Yale MS and Neuroimmunology Center
| | - Jayne Ness
- Center for Pediatric-Onset Demyelinating Disease at the Children’s Hospital of Alabama
| | - Yolanda Harris
- Center for Pediatric-Onset Demyelinating Disease at the Children’s Hospital of Alabama
| | | | - Leslie Benson
- Pediatric Multiple Sclerosis and Related Disorders Program at Boston Children’s Hospital
| | | | - Tanuja Chitnis
- Partners Pediatric Multiple Sclerosis Center at the Massachusetts General Hospital for Children
| | - Mark Gorman
- Pediatric Multiple Sclerosis and Related Disorders Program at Boston Children’s Hospital
| | | | | | - Timothy Lotze MD
- The Blue Bird Circle Clinic for Multiple Sclerosis, Texas Children’s Hospital
| | - Soe Mar
- Washington University Pediatric Multiple Sclerosis and other Demyelinating Disease Center, St. Louis
| | | | | | | | - John Rose
- Department of Pediatrics, University of Utah
| | | | - Teri Schreiner
- Rocky Mountain Multiple Sclerosis Center, University of Colorado at Denver
| | | | | | | | | | - Lauren Krupp
- Pediatric Multiple Sclerosis Center at New York University Langone Medical Center
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20
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Chi C, Shao X, Rhead B, Gonzales E, Smith JB, Xiang AH, Graves J, Waldman A, Lotze T, Schreiner T, Weinstock-Guttman B, Aaen G, Tillema JM, Ness J, Candee M, Krupp L, Gorman M, Benson L, Chitnis T, Mar S, Belman A, Casper TC, Rose J, Moodley M, Rensel M, Rodriguez M, Greenberg B, Kahn L, Rubin J, Schaefer C, Waubant E, Langer-Gould A, Barcellos LF. Admixture mapping reveals evidence of differential multiple sclerosis risk by genetic ancestry. PLoS Genet 2019; 15:e1007808. [PMID: 30653506 PMCID: PMC6353231 DOI: 10.1371/journal.pgen.1007808] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 01/30/2019] [Accepted: 11/02/2018] [Indexed: 01/22/2023] Open
Abstract
Multiple sclerosis (MS) is an autoimmune disease with high prevalence among populations of northern European ancestry. Past studies have shown that exposure to ultraviolet radiation could explain the difference in MS prevalence across the globe. In this study, we investigate whether the difference in MS prevalence could be explained by European genetic risk factors. We characterized the ancestry of MS-associated alleles using RFMix, a conditional random field parameterized by random forests, to estimate their local ancestry in the largest assembled admixed population to date, with 3,692 African Americans, 4,915 Asian Americans, and 3,777 Hispanics. The majority of MS-associated human leukocyte antigen (HLA) alleles, including the prominent HLA-DRB1*15:01 risk allele, exhibited cosmopolitan ancestry. Ancestry-specific MS-associated HLA alleles were also identified. Analysis of the HLA-DRB1*15:01 risk allele in African Americans revealed that alleles on the European haplotype conferred three times the disease risk compared to those on the African haplotype. Furthermore, we found evidence that the European and African HLA-DRB1*15:01 alleles exhibit single nucleotide polymorphism (SNP) differences in regions encoding the HLA-DRB1 antigen-binding heterodimer. Additional evidence for increased risk of MS conferred by the European haplotype were found for HLA-B*07:02 and HLA-A*03:01 in African Americans. Most of the 200 non-HLA MS SNPs previously established in European populations were not significantly associated with MS in admixed populations, nor were they ancestrally more European in cases compared to controls. Lastly, a genome-wide search of association between European ancestry and MS revealed a region of interest close to the ZNF596 gene on chromosome 8 in Hispanics; cases had a significantly higher proportion of European ancestry compared to controls. In conclusion, our study established that the genetic ancestry of MS-associated alleles is complex and implicated that difference in MS prevalence could be explained by the ancestry of MS-associated alleles.
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Affiliation(s)
- Calvin Chi
- Genetic Epidemiology and Genomics Laboratory, University of California, Berkeley, Berkeley, California, United States of America
- Computational Biology Graduate Group, University of California, Berkeley, Berkeley, California, United States of America
- * E-mail: (CC); (LB)
| | - Xiaorong Shao
- Genetic Epidemiology and Genomics Laboratory, University of California, Berkeley, Berkeley, California, United States of America
| | - Brooke Rhead
- Genetic Epidemiology and Genomics Laboratory, University of California, Berkeley, Berkeley, California, United States of America
- Computational Biology Graduate Group, University of California, Berkeley, Berkeley, California, United States of America
| | - Edlin Gonzales
- Department of Research & Evaluation, Kaiser Permanente Southern California, Los Angeles, California, United States of America
| | - Jessica B. Smith
- Department of Research & Evaluation, Kaiser Permanente Southern California, Los Angeles, California, United States of America
| | - Anny H. Xiang
- Department of Research & Evaluation, Kaiser Permanente Southern California, Los Angeles, California, United States of America
| | - Jennifer Graves
- Department of Neurology, University of California, San Francisco, San Francisco, California, United States of America
| | - Amy Waldman
- Leukodystrophy Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Timothy Lotze
- Neurology and Developmental Neuroscience Department, Texas Children’s Hospital, Houston, Texas, United States of America
| | - Teri Schreiner
- University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Bianca Weinstock-Guttman
- Department of Neurology, State University of New York, Buffalo, Buffalo, New York, United States of America
| | - Gregory Aaen
- Loma Linda University, Loma Linda, California, United States of America
| | - Jan-Mendelt Tillema
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Jayne Ness
- Children’s of Alabama, Birmingham, Alabama, United States of America
| | - Meghan Candee
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States of America
| | - Lauren Krupp
- Department of Neurology, NYU Langone Health, New York, New York, United States of America
| | - Mark Gorman
- Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Leslie Benson
- Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Tanuja Chitnis
- MassGeneral Hospital for Children, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Soe Mar
- Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Anita Belman
- Department of Neurology, NYU Langone Health, New York, New York, United States of America
| | - Theron Charles Casper
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States of America
| | - John Rose
- Department of Neurology, University of Utah, Salt Lake City, Utah, United States of America
| | - Manikum Moodley
- Center for Pediatric Neurosciences, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Mary Rensel
- Mellen Center, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Moses Rodriguez
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Benjamin Greenberg
- Neurology & Neurotherapeutics, University of Texas Southwestern, Dallas, Texas, United States of America
| | - Llana Kahn
- Children’s National Medical Center, Northwest Washington, D.C., United States of America
| | - Jennifer Rubin
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
| | - Catherine Schaefer
- Kaiser Permanente Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America
| | - Emmanuelle Waubant
- Department of Neurology, University of California, San Francisco, San Francisco, California, United States of America
| | - Annette Langer-Gould
- Kaiser Permanente, Southern California Permanente Medical Group, Pasadena, California, United States of America
- Los Angeles Medical Center, Neurology Department, Los Angeles, California, United States of America
| | - Lisa F. Barcellos
- Genetic Epidemiology and Genomics Laboratory, University of California, Berkeley, Berkeley, California, United States of America
- * E-mail: (CC); (LB)
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21
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Banerjee PP, Pang L, Soldan SS, Miah SM, Eisenberg A, Maru S, Waldman A, Smith EA, Rosenberg-Hasson Y, Hirschberg D, Smith A, Ablashi DV, Campbell KS, Orange JS. KIR2DL4-HLAG interaction at human NK cell-oligodendrocyte interfaces regulates IFN-γ-mediated effects. Mol Immunol 2018; 115:39-55. [PMID: 30482463 DOI: 10.1016/j.molimm.2018.09.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 09/11/2018] [Accepted: 09/30/2018] [Indexed: 12/12/2022]
Abstract
Interactions between germline-encoded natural killer (NK) cell receptors and their respective ligands on tumorigenic or virus-infected cells determine NK cell cytotoxic activity and/or cytokine secretion. NK cell cytokine responses can be augmented in and can potentially contribute to multiple sclerosis (MS), an inflammatory disease of the central nervous system focused upon the oligodendrocytes (OLs). To investigate mechanisms by which NK cells may contribute to MS pathogenesis, we developed an in vitro human model of OL-NK cell interaction. We found that activated, but not resting human NK cells form conjugates with, and mediate cytotoxicity against, human oligodendrocytes. NK cells, when in conjugate with OLs, rapidly synthesize and polarize IFN-γ toward the OLs. IFN-γ is capable of reducing myelin oligodendrocyte and myelin associated glycoproteins (MOG and MAG) content. This activity is independent of MHC class-I mediated inhibition via KIR2DL1, but dependent upon the interaction between NK cell-expressed KIR2DL4 and its oligodendrocyte-expressed ligand, HLA-G. NK cells from patients with MS express higher levels of IFN-γ following conjugation to OLs, more actively promote in vitro reduction of MOG and MAG and have higher frequencies of the KIR2DL4 positive population. These data collectively suggest a mechanism by which NK cells can promote pathogenic effects upon OLs.
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Affiliation(s)
- P P Banerjee
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX-77030, USA; Center for Human Immunobiology, Texas Children's Hospital, 1102 Bates St, Houston, TX, 77030, USA.
| | - L Pang
- Center for Human Immunobiology, Texas Children's Hospital, 1102 Bates St, Houston, TX, 77030, USA
| | - S S Soldan
- The Wistar Institute, 3601 Spruce St., Philadelphia, PA 19104, USA
| | - S M Miah
- Blood Cell Development and Function Program, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA
| | - A Eisenberg
- The Children's Hospital of Philadelphia Research Institute, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - S Maru
- The Children's Hospital of Philadelphia Research Institute, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - A Waldman
- The Children's Hospital of Philadelphia Research Institute, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - E A Smith
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX-77030, USA; Center for Human Immunobiology, Texas Children's Hospital, 1102 Bates St, Houston, TX, 77030, USA
| | - Y Rosenberg-Hasson
- Human Immune Monitoring Center, Stanford School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - D Hirschberg
- Human Immune Monitoring Center, Stanford School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - A Smith
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX-77030, USA; Center for Human Immunobiology, Texas Children's Hospital, 1102 Bates St, Houston, TX, 77030, USA
| | - D V Ablashi
- Human Herpes Virus 6 Foundation, 1482 East Valley Road, Suite 619 Santa Barbara, CA 93108, USA
| | - K S Campbell
- Blood Cell Development and Function Program, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA
| | - J S Orange
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX-77030, USA; Center for Human Immunobiology, Texas Children's Hospital, 1102 Bates St, Houston, TX, 77030, USA
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22
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Wells E, Hacohen Y, Waldman A, Tillema JM, Soldatos A, Ances B, Benseler S, Bielekova B, Dale RC, Dalmau J, Gaillard W, Gorman M, Greenberg B, Hyslop A, Pardo CA, Tasker RC, Yeh EA, Bar-Or A, Pittock S, Vanderver A, Banwell B. Author Correction: Neuroimmune disorders of the central nervous system in children in the molecular era. Nat Rev Neurol 2018; 14:749. [PMID: 30442924 DOI: 10.1038/s41582-018-0077-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In the original version of this Review published online and in print, the contribution of attendees of the International Neuroimmune Meeting to the content of the Review was not acknowledged. The author list has been corrected in the PDF and HTML versions of this article to acknowledge that the Review was written on behalf of attendees of the International Neuroimmune Meeting, and the names of the attendees have been added to the HTML version.
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Affiliation(s)
- Elizabeth Wells
- Center for Neuroscience and Behavioral Medicine, Children's National Health System, Washington, DC, USA
| | - Yael Hacohen
- Department of Neuroinflammation, Queen Square MS Centre, UCL Institute of Neurology, London, UK. .,Paediatric Neurology, Great Ormond Street Hospital, London, UK.
| | - Amy Waldman
- Department of Neurology and Pediatric Multiple Sclerosis Clinic, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jan M Tillema
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Ariane Soldatos
- National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | - Beau Ances
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Susanne Benseler
- Section of Rheumatology, Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Bibi Bielekova
- Neuroimmunological Diseases Unit, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | - Russel C Dale
- Institute for Neuroscience and Muscle Research, Kids Research Institute at the Children's Hospital at Westmead, University of Sydney, Westmead, New South Wales, Australia
| | - Josep Dalmau
- ICREA- IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - William Gaillard
- Center for Neuroscience and Behavioral Medicine, Children's National Health System, Washington, DC, USA
| | - Mark Gorman
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Benjamin Greenberg
- Department of Neurology and Neurotherapeutics and Department of Pediatrics, University of Texas Southwestern, Dallas, TX, USA
| | - Ann Hyslop
- Department of Pediatric Neurology and Epilepsy, Miami Children's Hospital, Miami, FL, USA
| | - Carlos A Pardo
- Johns Hopkins Transverse Myelitis Center, Baltimore, MD, USA
| | - Robert C Tasker
- Department of Neurocritical Care, Boston Children's Hospital, Boston, MA, USA
| | - E Ann Yeh
- Department of Paediatrics, Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Amit Bar-Or
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Sean Pittock
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Adeline Vanderver
- Department of Neurology and Pediatric Multiple Sclerosis Clinic, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brenda Banwell
- Department of Neurology and Pediatric Multiple Sclerosis Clinic, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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23
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Zhong J, Waldman A, Kandula S, Eaton B, Prabhu R, Huff S, Crocker I, Shu H. Outcomes of Whole Brain Radiation with Simultaneous In-Field Boost (SIB) for the Treatment of Brain Metastases. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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24
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Mar S, Liang S, Waltz M, Casper TC, Goyal M, Greenberg B, Weinstock-Guttman B, Rodriguez M, Aaen G, Belman A, Barcellos LF, Rose J, Gorman M, Benson L, Candee M, Chitnis T, Harris Y, Kahn I, Roalsted S, Hart J, Lotze T, Moodley M, Ness J, Rensel M, Rubin J, Schreiner T, Tillema JM, Waldman A, Krupp L, Graves JS, Waubant E. Several household chemical exposures are associated with pediatric-onset multiple sclerosis. Ann Clin Transl Neurol 2018; 5:1513-1521. [PMID: 30564618 PMCID: PMC6292189 DOI: 10.1002/acn3.663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 09/05/2018] [Indexed: 12/12/2022] Open
Abstract
Background There is limited information about the potential associations of multiple sclerosis (MS) and commonly used household chemicals. Methods We performed a case‐control study of exposures to common household chemicals during childhood in children with MS and healthy pediatric controls. Exposures to household products were collected from a comprehensive questionnaire (http://www.usnpmsc.org/Documents/EnvironmentalAssessment.pdf) completed by parents at the time of enrollment in the study. Cases included children diagnosed with MS or clinically isolated syndrome with at least two silent T2 bright lesions on MRI, recruited within 4 years of disease onset from 16 pediatric MS clinics in the USA. Multivariate analyses using logistic regression were adjusted for possible confounders including age, sex, race, ethnicity, mother's highest level of education, and urban versus rural living. Results Questionnaire responses to household chemicals were available for 312 eligible cases (median age 15.7 years, 63% girls) and 490 healthy controls (median age 15.0, 57% girls). Exposure to rodenticides (odds ratio [OR] 2.10, 95% confidence interval [CI] 1.35–3.26, P ≤ 0.001), weed control agents (OR 1.99, 95% CI 1.36–2.92, P ≤ 0.001) and products for plant/tree disease control (OR 2.72, 95% CI 1.54–4.82, P ≤ 0.001) anytime during childhood were associated with an increased risk for pediatric‐onset MS in adjusted and multiple comparisons analyses. Conclusions Our findings suggest that exposure to specific household chemicals during early childhood is associated with the risk of developing pediatric‐onset MS. Future studies are needed to elucidate a causal relationship and the exact agents involved.
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Affiliation(s)
- Soe Mar
- Pediatric Multiple Sclerosis and other Demyelinating Disease Center Washington University in St. Louis St. Louis Missouri
| | - Shannon Liang
- Department of Neurology UC Davis Children's Hospital Sacramento California
| | - Michael Waltz
- Data Coordinating and Analysis Center University of Utah Salt Lake City Utah
| | - T Charles Casper
- Data Coordinating and Analysis Center University of Utah Salt Lake City Utah
| | - Manu Goyal
- Department of Radiology Washington University in St. Louis St. Louis Missouri
| | | | - Bianca Weinstock-Guttman
- Jacobs Pediatric Multiple Sclerosis Center State University of New York at Buffalo Buffalo New York
| | - Moses Rodriguez
- Mayo Clinic Pediatric Multiple Sclerosis Center Mayo Clinic Rochester Minnesota
| | - Gregory Aaen
- Pediatric Multiple Sclerosis Center Loma Linda University Children's Hospital Loma Linda California
| | - Anita Belman
- Lourie Center for Pediatric Multiple Sclerosis Stony Brook University Hospital New York New York
| | - Lisa F Barcellos
- Depatment of Epidemiology University of California Berkeley Northern California
| | - John Rose
- Department of Neurology University of Utah Salt Lake City Utah
| | - Mark Gorman
- Pediatric Multiple Sclerosis and Related Disorders Program Boston Children's Hospital Boston Massachusetts
| | - Leslie Benson
- Pediatric Multiple Sclerosis and Related Disorders Program Boston Children's Hospital Boston Massachusetts
| | - Meghan Candee
- Primary Children's Hospital University of Utah Salt Lake City Utah
| | - Tanjua Chitnis
- Partners Pediatric Multiple Sclerosis Center Massachusetts General Hospital Boston Massachusetts
| | - Yolanda Harris
- Center for Pediatric-Onset Demyelinating Disease Children's Hospital of Alabama University of Alabama Birmingham Alabama
| | - Ilana Kahn
- Children's National Medical Center Washington DC
| | - Shelly Roalsted
- Data Coordinating and Analysis Center University of Utah Salt Lake City Utah
| | - Janace Hart
- Pediatric Multiple Sclerosis Center University of California San Francisco San Francisco California
| | - Timothy Lotze
- The Blue Bird Circle Clinic for Multiple Sclerosis Texas Children's Hospital Baylor College of Medicine Houston Texas
| | - Manikum Moodley
- Mellen Center for Multiple Sclerosis Cleveland Clinic Cleveland Ohio
| | - Jayne Ness
- Center for Pediatric-Onset Demyelinating Disease Children's Hospital of Alabama University of Alabama Birmingham Alabama
| | - Mary Rensel
- Mellen Center for Multiple Sclerosis Cleveland Clinic Cleveland Ohio
| | | | - Teri Schreiner
- Rocky Mountain Multiple Sclerosis Center Children's Hospital Colorado University of Colorado at Denver Aurora Colorado
| | - Jan-Mendelt Tillema
- Mayo Clinic Pediatric Multiple Sclerosis Center Mayo Clinic Rochester Minnesota
| | - Amy Waldman
- Children's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Lauren Krupp
- Pediatric Multiple Sclerosis Center New York University New York New York
| | - Jennifer S Graves
- Pediatric Multiple Sclerosis Center University of California San Francisco San Francisco California
| | - Emmanuelle Waubant
- Pediatric Multiple Sclerosis Center University of California San Francisco San Francisco California
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25
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Nourbakhsh B, Rutatangwa A, Waltz M, Rensel M, Moodley M, Graves J, Casper TC, Waldman A, Belman A, Greenberg B, Goyal M, Harris Y, Kahn I, Lotze T, Mar S, Schreiner T, Aaen G, Hart J, Ness J, Rubin J, Tillema JM, Krupp L, Gorman M, Benson L, Rodriguez M, Chitnis T, Rose J, Candee M, Weinstock-Guttman B, Shao X, Barcellos L, James J, Waubant E. Heterogeneity in association of remote herpesvirus infections and pediatric MS. Ann Clin Transl Neurol 2018; 5:1222-1228. [PMID: 30349857 PMCID: PMC6186938 DOI: 10.1002/acn3.636] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/08/2018] [Accepted: 08/10/2018] [Indexed: 12/21/2022] Open
Abstract
Objective While prior Epstein–Barr virus (EBV) infection has been consistently associated with subsequent risk of developing multiple sclerosis (MS), the association with other common herpesviruses has been more controversial. Our objectives were to determine whether remote infection with EBV and other common herpesviruses affect the susceptibility to pediatric MS and if there are interactions between genetic and demographic factors and viral infections. Methods Cases with pediatric‐onset MS or clinically isolated syndrome within 4 years of disease onset, and controls were recruited from 16 American pediatric MS centers. Logistic regression models adjusted for potential confounders assessed the association between case status and serological evidence for past infection with EBV, cytomegalovirus (CMV), Herpes Simplex viruses‐1 (HSV‐1) and ‐2. We determined the heterogeneity of the effect of viral infection on the risk of having MS according to race, ethnicity and HLA‐DRB1:1501 status. Results A total of 356 pediatric cases and 493 controls were recruited. In multivariable models, EBV‐viral capsid antigen (VCA) seropositivity was associated with increased odds of having MS by 7.4 times (95% CI: 4.5–12.0, P < 0.001). Seropositivity for HSV‐1 was also associated with increased odds of having MS (OR 1.54, 95% CI: 1.06–2.25, P = 0.025) but this increase was seen only in Whites (OR = 2.18, 95% CI 1.35–3.52, P < 0.001) and those negative for HLA‐DRB1*1501 (OR = 1.89, 95% CI 1.17–3.03, P = 0.009). The effect of remote EBV infection on the risk of pediatric MS depended on race and HLA‐DRB1*15:01 status. Interpretation EBV seropositivity is strongly associated with pediatric MS, as is HSV‐1 seropositivity in subjects negative for HLA‐DRB1*15:01. Our report of interactions between select viral exposures, and age, race and DRB1 status suggests a complex effect of environmental and genetic risk factors on MS development.
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Affiliation(s)
| | - Alice Rutatangwa
- Department of Neurology Stony Brook University Hospital Stony Brook New York
| | - Michael Waltz
- Department of Pediatrics University of Utah Salt Lake City Utah
| | - Mary Rensel
- Mellen Center for Multiple Sclerosis Cleveland Clinic Cleveland Ohio
| | - Manikum Moodley
- Mellen Center for Multiple Sclerosis Cleveland Clinic Cleveland Ohio
| | | | | | - Amy Waldman
- Children's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Anita Belman
- Lourie Center for Pediatric MS at Stony Brook University Hospital Stony Brook New York
| | | | - Manu Goyal
- Washington University Pediatric MS and other Demyelinating Disease Center Washington University in St. Louis St. Louis Missouri
| | - Yolanda Harris
- Center for Pediatric-Onset Demyelinating Disease at the Children's of Alabama University of Alabama Birmingham Alabama
| | - Ilana Kahn
- Children's National Medical Center Washington District of Columbia
| | - Timothy Lotze
- The Blue Bird Circle Clinic for Multiple Sclerosis Texas Children's Hospital Baylor College of Medicine Houston Texas
| | - Soe Mar
- Washington University Pediatric MS and other Demyelinating Disease Center Washington University in St. Louis St. Louis Missouri
| | - Teri Schreiner
- Rocky Mountain MS Center Children's Hospital Colorado University of Colorado at Denver Aurora Colorado
| | - Gregory Aaen
- Pediatric Multiple Sclerosis Center at Loma Linda University Children's Hospital Loma Linda University Loma Linda California
| | - Janace Hart
- UCSF Regional Pediatric MS Center San Francisco California
| | - Jayne Ness
- Center for Pediatric-Onset Demyelinating Disease at the Children's of Alabama University of Alabama Birmingham Alabama
| | | | | | - Lauren Krupp
- Pediatric MS Center New York University New York New York
| | - Mark Gorman
- Pediatric Multiple Sclerosis and Related Disorders Program at Boston Children's Hospital Harvard Medical School Boston Massachusetts
| | - Leslie Benson
- Pediatric Multiple Sclerosis and Related Disorders Program at Boston Children's Hospital Harvard Medical School Boston Massachusetts
| | - Moses Rodriguez
- Mayo Clinic Pediatric MS Center Mayo Clinic Rochester Minnesota
| | - Tanuja Chitnis
- Partners Pediatric MS Center Massachusetts General Hospital Boston Massachusetts
| | - John Rose
- Department of Neurology University of Utah Salt Lake City Utah
| | - Meghan Candee
- Primary Children's Hospital University of Utah Salt Lake City Utah
| | - Bianca Weinstock-Guttman
- The Pediatric MS Center at the Jacobs Neurological Institute State University of New York at Buffalo Buffalo New York
| | - Xiaorong Shao
- School of Public Health University of California, Berkeley Berkeley California
| | - Lisa Barcellos
- School of Public Health University of California, Berkeley Berkeley California
| | - Judith James
- University of Oklahoma Health Sciences Center Oklahoma City Oklahoma
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26
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Pakpoor J, Seminatore B, Graves J, Schreiner T, Waldman A, Lotze T, Belman A, Greenberg B, Weinstock-Guttman B, Aaen G, Tillema J, McDonald J, Hart J, Ness J, Harris Y, Rubin J, Candee M, Krupp L, Gorman M, Benson L, Rodriguez M, Chitnis T, Mar S, Kahn I, Rose J, Carmichael S, Roalstad S, Waltz M, Casper T, Waubant E. Dietary factors and pediatric multiple sclerosis: A case-control study. Mult Scler 2018; 24:1067-1076. [PMID: 28608728 PMCID: PMC5711616 DOI: 10.1177/1352458517713343] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The role of diet in multiple sclerosis (MS) is largely uncharacterized, particularly as it pertains to pediatric-onset disease. OBJECTIVE To determine the association between dietary factors and MS in children. METHODS Pediatric MS patients and controls were recruited from 16 US centers (MS or clinically isolated syndrome onset before age 18, <4 years from symptom onset and at least 2 silent lesions on magnetic resonance imaging). The validated Block Kids Food Screener questionnaire was administered 2011-2016. Chi-squared test compared categorical variables, Kruskal-Wallis test compared continuous variables, and multivariable logistic regression analysis was performed. RESULTS In total, 312 cases and 456 controls were included (mean ages 15.1 and 14.4 years). In unadjusted analyses, there was no difference in intake of fats, proteins, carbohydrates, sugars, fruits, or vegetables. Dietary iron was lower in cases ( p = 0.04), and cases were more likely to consume below recommended guidelines of iron (77.2% of cases vs 62.9% of controls, p < 0.001). In multivariable analysis, iron consumption below recommended guidelines was associated with MS (odds ratio = 1.80, p < 0.01). CONCLUSION Pediatric MS cases may be less likely to consume sufficient iron compared to controls, and this warrants broader study to characterize a temporal relationship. No other significant difference in intake of most dietary factors was found.
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Affiliation(s)
- J. Pakpoor
- Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - B. Seminatore
- Multiple Sclerosis Center, University of California, San Francisco, CA
| | - J. Graves
- Multiple Sclerosis Center, University of California, San Francisco, CA
| | - T. Schreiner
- University of Colorado School of Medicine, Neurology
| | - A. Waldman
- Children’s Hospital of Philadelphia, Neurology
| | - T. Lotze
- Texas Children’s Hospital, Child Neurology
| | - A. Belman
- Stony Brook University Medical Center, Department of Neurology, Neurology
| | | | | | - G. Aaen
- Loma Linda University, Neurology
| | | | - J. McDonald
- Multiple Sclerosis Center, University of California, San Francisco, CA
| | - J. Hart
- University of California, San Francisco, Regional Pediatric MS Center, Neurology
| | - J. Ness
- University of Alabama at Birmingham, Pediatrics
| | - Y. Harris
- University of Alabama at Birmingham, Pediatrics
| | - J. Rubin
- Ann & Robert Lurie Children's Hospital of Chicago, Neurology
| | | | - L. Krupp
- Stony Brook University Medical Center, Department of Neurology, Neurology
| | - M. Gorman
- Massachusetts General Hospital, Partners Pediatric Multiple Sclerosis Center
| | - L. Benson
- Massachusetts General Hospital, Partners Pediatric Multiple Sclerosis Center
| | | | | | - S. Mar
- Washington University St. Louis, Neurology
| | - I. Kahn
- Children’s National Medical Center, Washington, D.C
| | - J. Rose
- University of Utah, Neurology
| | - S.L. Carmichael
- Department of Pediatrics Division of Neonatal and Developmental Medicine, Stanford University, California, USA
| | | | | | | | - E. Waubant
- Multiple Sclerosis Center, University of California, San Francisco, CA
- University of California, San Francisco, Regional Pediatric MS Center, Neurology
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27
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Gottlieb-Smith R, Waldman A. First Presentation of an Acquired Demyelinating Syndrome. J Pediatr Neurol 2018. [DOI: 10.1055/s-0037-1606380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractAcquired demyelinating syndromes (ADS) present with acute or subacute monofocal or polyfocal neurologic deficits localizing to the central nervous system. The clinical features of distinct ADS have been carefully characterized including optic neuritis, transverse myelitis, and acute disseminated encephalomyelitis. These disorders may all be monophasic disorders. Alternatively, optic neuritis, partial transverse myelitis, and acute disseminated encephalomyelitis may be first presentations of a relapsing or polyphasic neuroinflammatory disorder, such as multiple sclerosis or neuromyelitis optica. The clinical features of these disorders and the differential diagnosis are discussed in this article.
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Affiliation(s)
- Rachel Gottlieb-Smith
- Division of Child Neurology, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Amy Waldman
- Division of Child Neurology, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
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28
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Suleiman L, Waubant E, Aaen G, Belman A, Benson L, Candee M, Chitnis T, Gorman M, Goyal M, Greenberg B, Harris Y, Hart J, Kahn I, Krupp L, Lotze T, Mar S, Moodley M, Ness J, Nourbakhsh B, Rensel M, Rodriguez M, Rose J, Rubin J, Schreiner T, Tillema JM, Waldman A, Weinstock-Guttman B, Casper TC, Waltz M, Graves JS. Early infectious exposures are not associated with increased risk of pediatric-onset multiple sclerosis. Mult Scler Relat Disord 2018; 22:103-107. [PMID: 29653437 DOI: 10.1016/j.msard.2018.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 02/16/2018] [Accepted: 03/20/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We sought to determine if early infectious exposures such as daycare, early use of antibiotics, vaccinations and other germ exposures including pacifier use and playing on grass are associated with multiple sclerosis (MS) risk in children. METHODS This was a case-control study of children with MS or clinically isolated syndrome (CIS) and healthy controls enrolled at sixteen clinics participating in the US Network of Pediatric MS Centers. Parents completed a comprehensive environmental questionnaire that captured early infectious exposures, habits, and illnesses in the first five years of life. A panel of at least two pediatric MS specialists confirmed diagnosis of participants. Association of early infectious variables with diagnosis was assessed via multivariable logistic regression analyses, adjusting for age, sex, race, ethnicity, US birth region, and socioeconomic status (SES). RESULTS Questionnaire responses for 326 eligible cases (mean age 14.9, 63.5% girls) and 506 healthy pediatric subjects (mean age 14.4, 56.9% girls) were included in analyses. History of flu with high fever before age five (p = 0.01), playing outside in grass and use of special products to treat head lice or scabies (p = 0.04) were associated with increased risk of MS in unadjusted analyses. In the multivariable model adjusted for age, sex, race, ethnicity, and mother's highest educational attainment, these results were not statistically significant. Notably, antibiotic use (p = 0.22) and regular daycare attendance before age 6 (p = 0.09) were not associated with odds of developing MS. CONCLUSION Early infectious factors investigated in this study were not associated with MS risk.
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Affiliation(s)
- Leena Suleiman
- Pediatric Multiple Sclerosis Center, University of California San Francisco, San Francisco, CA, USA.
| | - Emmanuelle Waubant
- Pediatric Multiple Sclerosis Center, University of California San Francisco, San Francisco, CA, USA
| | - Gregory Aaen
- Pediatric Multiple Sclerosis Center, Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Anita Belman
- Lourie Center for Pediatric Multiple Sclerosis, Stony Brook University Hospital, Stony Brook, New York, NY, USA
| | - Leslie Benson
- Pediatric Multiple Sclerosis and Related Disorders Program, Boston Children's Hospital, Boston, MA, USA
| | - Meghan Candee
- Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| | - Tanuja Chitnis
- Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston, MA, USA
| | - Mark Gorman
- Pediatric Multiple Sclerosis and Related Disorders Program, Boston Children's Hospital, Boston, MA, USA
| | - Manu Goyal
- University Pediatric Multiple Sclerosis and other Demyelinating Disease Center, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | | | - Yolanda Harris
- Center for Pediatric-Onset Demyelinating Disease, Children's Hospital of Alabama, University of Alabama, Birmingham, AL, USA
| | - Janace Hart
- Pediatric Multiple Sclerosis Center, University of California San Francisco, San Francisco, CA, USA
| | - Ilana Kahn
- Children's National Medical Center, Washington, DC, USA
| | - Lauren Krupp
- Pediatric Multiple Sclerosis Center, New York University, New York, NY, USA
| | - Timothy Lotze
- The Blue Bird Circle Clinic for Multiple Sclerosis, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Soe Mar
- University Pediatric Multiple Sclerosis and other Demyelinating Disease Center, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Manikum Moodley
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
| | - Jayne Ness
- Center for Pediatric-Onset Demyelinating Disease, Children's Hospital of Alabama, University of Alabama, Birmingham, AL, USA
| | - Bardia Nourbakhsh
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Mary Rensel
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
| | - Moses Rodriguez
- Mayo Clinic Pediatric Multiple Sclerosis Center, Mayo Clinic, Rochester, MN, USA
| | - John Rose
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | | | - Teri Schreiner
- Rocky Mountain Multiple Sclerosis Center, Children's Hospital Colorado, University of Colorado at Denver, Aurora, CO, USA
| | - Jan-Mendelt Tillema
- Mayo Clinic Pediatric Multiple Sclerosis Center, Mayo Clinic, Rochester, MN, USA
| | - Amy Waldman
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Bianca Weinstock-Guttman
- Pediatric Multiple Sclerosis Center, Jacobs Neurological Institute, State University of New York at Buffalo, Buffalo, NY, USA
| | - T Charles Casper
- Data Coordinating and Analysis Center, University of Utah, Salt Lake City, Utah, USA
| | - Michael Waltz
- Data Coordinating and Analysis Center, University of Utah, Salt Lake City, Utah, USA
| | - Jennifer S Graves
- Pediatric Multiple Sclerosis Center, University of California San Francisco, San Francisco, CA, USA
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29
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Azary S, Schreiner T, Graves J, Waldman A, Belman A, Guttman BW, Aaen G, Tillema JM, Mar S, Hart J, Ness J, Harris Y, Krupp L, Gorman M, Benson L, Rodriguez M, Chitnis T, Rose J, Barcellos LF, Lotze T, Carmichael SL, Roalstad S, Casper CT, Waubant E. Contribution of dietary intake to relapse rate in early paediatric multiple sclerosis. J Neurol Neurosurg Psychiatry 2018; 89:28-33. [PMID: 28993476 PMCID: PMC5732893 DOI: 10.1136/jnnp-2017-315936] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 08/09/2017] [Accepted: 08/09/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The role of diet in multiple sclerosis (MS) course remains largely unknown. Children with MS have a higher relapse rate compared with MS in adults. Thus, studying the effect of diet on relapse rate in this age group is likely to provide more robust answers. METHODS This is a multicentre study done at 11 paediatric MS centres in the USA. Patients with relapsing-remitting MS (RRMS) or clinically isolated syndrome (CIS) with disease onset before 18 years of age and duration of less than 4 years were included in this study. Dietary intake during the week before enrolment was assessed with the validated Block Kids Food Screener. The outcome of the study was time from enrolment to the next relapse. 219 patients with paediatric RRMS or CIS were enrolled. Each 10% increase in energy intake from fat increased the hazard of relapse by 56% (adjusted HR 1.56, 95% CI 1.05 to 2.31, p=0.027), and in particular each 10% increase in saturated fat tripled this hazard (adjusted HR: 3.37, 95% CI 1.34 to 8.43, p=0.009). In contrast, each additional one cup equivalent of vegetable decreased the hazard of relapse by 50% (adjusted HR: 0.50, 95% CI 0.27 to 0.91, p=0.024). These associations remained with mutual adjustment and persisted when adjusting for baseline 25(OH) vitamin D serum level. Other studied nutrients were not associated with relapse. CONCLUSIONS This study suggests that in children with MS, high energy intake from fat, especially saturated fat, may increase the hazard to relapse, while vegetable intake may be independently protective.
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Affiliation(s)
- Saeedeh Azary
- Department of Neurology, UCSF Regional Pediatric MS Center, San Francisco, California, USA
| | - Teri Schreiner
- Department of Neurology, University of Colorado, Aurora, Colorado, USA
| | - Jennifer Graves
- Department of Neurology, UCSF Regional Pediatric MS Center, San Francisco, California, USA
| | - Amy Waldman
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anita Belman
- Department of Neurology, SUNY Stony Brook, Stony Brook, New York, USA
| | - Bianca Weinstock Guttman
- Department of Neurology, The Pediatric MS Center at the Jacobs Neurological Institute, SUNY, Buffalo, New York, USA
| | - Gregory Aaen
- Department of Child Neurology, Loma Linda University, Loma Linda, California, USA
| | | | - Soe Mar
- Division of Pediatric Neurology, Washington University, St. Louis, Missouri, USA
| | - Janace Hart
- Department of Neurology, UCSF Regional Pediatric MS Center, San Francisco, California, USA
| | - Jayne Ness
- Department of Neurology, Alabama Pediatric MS Center, Birmingham, Alabama, USA
| | - Yolanda Harris
- Department of Neurology, Alabama Pediatric MS Center, Birmingham, Alabama, USA
| | - Lauren Krupp
- Department of Neurology, New York University, New York City, New York, USA
| | - Mark Gorman
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Leslie Benson
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Moses Rodriguez
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Tanuja Chitnis
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - John Rose
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Lisa F Barcellos
- Division of Epidemiology, UC Berkeley, Berkeley, California, USA
| | - Tim Lotze
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Suzan L Carmichael
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Shelly Roalstad
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Charles T Casper
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Emmanuelle Waubant
- Department of Neurology, UCSF Regional Pediatric MS Center, San Francisco, California, USA
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30
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Gianfrancesco MA, Stridh P, Shao X, Rhead B, Graves JS, Chitnis T, Waldman A, Lotze T, Schreiner T, Belman A, Greenberg B, Weinstock-Guttman B, Aaen G, Tillema JM, Hart J, Caillier S, Ness J, Harris Y, Rubin J, Candee M, Krupp L, Gorman M, Benson L, Rodriguez M, Mar S, Kahn I, Rose J, Roalstad S, Casper TC, Shen L, Quach H, Quach D, Hillert J, Hedstrom A, Olsson T, Kockum I, Alfredsson L, Schaefer C, Barcellos LF, Waubant E. Genetic risk factors for pediatric-onset multiple sclerosis. Mult Scler 2017; 24:1825-1834. [PMID: 28980494 DOI: 10.1177/1352458517733551] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Strong evidence supports the role of both genetic and environmental factors in pediatric-onset multiple sclerosis (POMS) etiology. OBJECTIVE We comprehensively investigated the association between established major histocompatibility complex (MHC) and non-MHC adult multiple sclerosis (MS)-associated variants and susceptibility to POMS. METHODS Cases with onset <18 years (n = 569) and controls (n = 16,251) were included from the United States and Sweden. Adjusted logistic regression and meta-analyses were performed for individual risk variants and a weighted genetic risk score (wGRS) for non-MHC variants. Results were compared to adult MS cases (n = 7588). RESULTS HLA-DRB1*15:01 was strongly associated with POMS (odds ratio (OR)meta = 2.95, p < 2.0 × 10-16). Furthermore, 28 of 104 non-MHC variants studied (23%) were associated (p < 0.05); POMS cases carried, on average, a higher burden of these 28 variants compared to adults (ORavg = 1.24 vs 1.13, respectively), though the difference was not significant. The wGRS was strongly associated with POMS (ORmeta = 2.77, 95% confidence interval: 2.33, 3.32, p < 2.0 × 10-16) and higher, on average, when compared to adult cases. Additional class III risk variants in the MHC region associated with POMS were revealed after accounting for HLA-DRB1*15:01 and HLA-A*02. CONCLUSION Pediatric and adult MS share many genetic variants suggesting similar biological processes are present. MHC variants beyond HLA-DRB1*15:01 and HLA-A*02 are also associated with POMS.
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Affiliation(s)
- Milena A Gianfrancesco
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Pernilla Stridh
- Department of Clinical Neuroscience and Center for Molecular Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Xiaorong Shao
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Brooke Rhead
- Computational Biology Graduate Group, University of California, Berkeley, Berkeley, CA, USA
| | - Jennifer S Graves
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Tanuja Chitnis
- Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital for Children, Boston, MA, USA
| | - Amy Waldman
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Timothy Lotze
- Blue Bird Circle Multiple Sclerosis Center, Baylor College of Medicine, Houston, TX, USA
| | - Teri Schreiner
- Children's Hospital Colorado, University of Colorado, Denver, CO, USA
| | - Anita Belman
- The Lourie Center for Pediatric MS, Stony Brook Children's Hospital, Stony Brook, NY, USA
| | - Benjamin Greenberg
- Department of Neurology & Neurotherapeutics, University of Texas Southwestern, Dallas, TX, USA
| | - Bianca Weinstock-Guttman
- Pediatric Multiple Sclerosis Center, Jacobs Neurological Institute, SUNY Buffalo, Buffalo, NY, USA
| | - Gregory Aaen
- Pediatric MS Center, Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Jan M Tillema
- Pediatric MS Center, Mayo Clinic, Rochester, MN, USA
| | - Janace Hart
- Department of Neurology and Regional Pediatric MS Center, University of California, San Francisco, San Francisco, CA, USA
| | - Stacy Caillier
- Department of Neurology and Regional Pediatric MS Center, University of California, San Francisco, San Francisco, CA, USA
| | - Jayne Ness
- Center for Pediatric Onset Demyelinating Disease, University of Alabama and Children's Hospital of Alabama, Birmingham, AL, USA
| | - Yolanda Harris
- Center for Pediatric Onset Demyelinating Disease, University of Alabama and Children's Hospital of Alabama, Birmingham, AL, USA
| | - Jennifer Rubin
- Division of Neurology, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Meghan Candee
- University of Utah and Primary Children's Hospital, Salt Lake City, UT, USA
| | - Lauren Krupp
- The Lourie Center for Pediatric MS, Stony Brook Children's Hospital, Stony Brook, NY, USA
| | | | | | | | - Soe Mar
- Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, USA
| | - Ilana Kahn
- Children's National Medical Center, Washington, DC, USA
| | - John Rose
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Shelly Roalstad
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - T Charles Casper
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ling Shen
- Division of Research, Kaiser Permanente, Oakland, CA, USA
| | - Hong Quach
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Diana Quach
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Jan Hillert
- Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden
| | - Anna Hedstrom
- Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience and Center for Molecular Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ingrid Kockum
- Department of Clinical Neuroscience and Center for Molecular Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Lars Alfredsson
- Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden/Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Catherine Schaefer
- Division of Research, Kaiser Permanente, Oakland, CA, USA/Research Program on Genes, Environment and Health, Kaiser Permanente, Oakland, CA
| | - Lisa F Barcellos
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA/Computational Biology Graduate Group, University of California, Berkeley, Berkeley, CA, USA; Division of Research, Kaiser Permanente, Oakland, CA, USA
| | - Emmanuelle Waubant
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
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Adang LA, Sherbini O, Ball L, Bloom M, Darbari A, Amartino H, DiVito D, Eichler F, Escolar M, Evans SH, Fatemi A, Fraser J, Hollowell L, Jaffe N, Joseph C, Karpinski M, Keller S, Maddock R, Mancilla E, McClary B, Mertz J, Morgart K, Langan T, Leventer R, Parikh S, Pizzino A, Prange E, Renaud DL, Rizzo W, Shapiro J, Suhr D, Suhr T, Tonduti D, Waggoner J, Waldman A, Wolf NI, Zerem A, Bonkowsky JL, Bernard G, van Haren K, Vanderver A. Revised consensus statement on the preventive and symptomatic care of patients with leukodystrophies. Mol Genet Metab 2017; 122:18-32. [PMID: 28863857 PMCID: PMC8018711 DOI: 10.1016/j.ymgme.2017.08.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/18/2017] [Accepted: 08/19/2017] [Indexed: 12/21/2022]
Abstract
Leukodystrophies are a broad class of genetic disorders that result in disruption or destruction of central myelination. Although the mechanisms underlying these disorders are heterogeneous, there are many common symptoms that affect patients irrespective of the genetic diagnosis. The comfort and quality of life of these children is a primary goal that can complement efforts directed at curative therapies. Contained within this report is a systems-based approach to management of complications that result from leukodystrophies. We discuss the initial evaluation, identification of common medical issues, and management options to establish a comprehensive, standardized care approach. We will also address clinical topics relevant to select leukodystrophies, such as gallbladder pathology and adrenal insufficiency. The recommendations within this review rely on existing studies and consensus opinions and underscore the need for future research on evidence-based outcomes to better treat the manifestations of this unique set of genetic disorders.
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Affiliation(s)
- Laura A Adang
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Omar Sherbini
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Laura Ball
- Center for Translational Science, Children's National Medical Center, Washington, DC, USA; Department of Physical Medicine and Rehabilitation, Children's National Medical Center, Washington, DC, USA
| | - Miriam Bloom
- Department of Pediatrics, Children's National Medical Center, Washington, DC, USA; Complex Care Program, Children's National Medical Center, Washington, DC, USA
| | - Anil Darbari
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's National Medical Center, Washington, DC, USA
| | - Hernan Amartino
- Servicio de Neurología Infantil, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Donna DiVito
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Florian Eichler
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Maria Escolar
- Department of Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sarah H Evans
- Center for Translational Science, Children's National Medical Center, Washington, DC, USA; Department of Physical Medicine and Rehabilitation, Children's National Medical Center, Washington, DC, USA
| | - Ali Fatemi
- The Hugo W. Moser Research Institute, The Kennedy Krieger Institute, Baltimore, MD, USA
| | - Jamie Fraser
- Rare Disease Institute, Children's National Medical Center, Washington, DC, USA
| | - Leslie Hollowell
- Complex Care Program, Children's National Medical Center, Washington, DC, USA
| | - Nicole Jaffe
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christopher Joseph
- The Hugo W. Moser Research Institute, The Kennedy Krieger Institute, Baltimore, MD, USA
| | - Mary Karpinski
- Pediatric Multiple Sclerosis Center, Women and Children's Hospital, Buffalo, NY, USA
| | - Stephanie Keller
- Division of Pediatric Neurology, Emory University, Atlanta, GA, USA
| | - Ryan Maddock
- Department of Pediatrics, Children's National Medical Center, Washington, DC, USA
| | - Edna Mancilla
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Bruce McClary
- The Hugo W. Moser Research Institute, The Kennedy Krieger Institute, Baltimore, MD, USA
| | - Jana Mertz
- Autism Spectrum Disorders Center, Women and Children's Hospital, Buffalo, NY, USA
| | - Kiley Morgart
- Psychiatric Social Work Program, The Kennedy Krieger Institute, Baltimore, MD, USA
| | - Thomas Langan
- Hunter James Kelly Research Institute, Buffalo, NY, USA
| | - Richard Leventer
- Department of Paediatrics, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
| | - Sumit Parikh
- Neurogenetics, Neurologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Amy Pizzino
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Erin Prange
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Deborah L Renaud
- Division of Child and Adolescent Neurology, Departments of Neurology and Pediatrics, Mayo Clinic, Rochester, MN, USA
| | - William Rizzo
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jay Shapiro
- The Hugo W. Moser Research Institute, The Kennedy Krieger Institute, Baltimore, MD, USA
| | | | | | - Davide Tonduti
- Department of Child Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Amy Waldman
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Nicole I Wolf
- Department of Child Neurology, VU University Medical Centre and Amsterdam Neuroscience, Amsterdam, The Netherlands
| | | | - Joshua L Bonkowsky
- Department of Pediatrics, Division of Pediatric Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Genevieve Bernard
- Department of Neurology and Neurosurgery, McGill University, Montreal, Canada; Department of Pediatrics, McGill University, Montreal, Canada; Department of Medical Genetics, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada; Child Health and Human Development Program, Research Institute of the McGill University Health Center, Montreal, Canada
| | - Keith van Haren
- Department of Neurology, Lucile Packard Children's Hospital and Stanford University School of Medicine, Stanford, CA, USA
| | - Adeline Vanderver
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Center for Translational Science, Children's National Medical Center, Washington, DC, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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32
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Yeh EA, Grover SA, Powell VE, Alper G, Banwell BL, Edwards K, Gorman M, Graves J, Lotze TE, Mah JK, Mednick L, Ness J, Obadia M, Slater R, Waldman A, Waubant E, Schwartz CE. Impact of an electronic monitoring device and behavioral feedback on adherence to multiple sclerosis therapies in youth: results of a randomized trial. Qual Life Res 2017; 26:2333-2349. [PMID: 28393317 PMCID: PMC6149210 DOI: 10.1007/s11136-017-1571-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To report the results of a randomized controlled trial using an electronic monitoring device (EM) plus a motivational interviewing (MI) intervention to enhance adherence to disease-modifying therapies (DMT) in pediatric MS. METHODS Fifty-two youth with MS (16.03 ± 2.2 years) were randomized to receive either MI (n = 25) (target intervention) or a MS medication video (n = 27) (attention control). Primary endpoint was change in adherence. Secondary outcomes included changes in quality of life, well-being and self-efficacy. Random effects modeling and Cohen's effect size computation evaluated intervention impact. RESULTS Longitudinal random effect models revealed that the MI group decreased their EM adherence (GroupxTime interaction = -0.19), while increasing frequency of parental DMT reminder (26.01)/administration (11.69). We found decreased EM use in the MI group at 6 months (Cohen's d = -0.61), but increased pharmacy refill adherence (d = 0.23). Parental reminders about medication increased in MI subjects vs controls (d = 0.59 at 3 months; d = 0.70 at 6 months). We found increases in self-reported adherence (d = 0.21) at 3 but not 6 months, fewer barriers to adherence at three (d = -0.58) and six months (d = -0.31), better physical (d = 0.23 at 3 months; d = 0.45 at 6 months), emotional (d = 0.25 at 3 months) and self-efficacy function (d = 0.55 at 3 months; 0.48 at 6 months), but worse well-being, including self-acceptance (d = -0.53 at 6 months) and environmental mastery (d = -0.42 at 3 and 6 months) in intervention as compared to control patients. CONCLUSIONS Participants receiving MI + EM experienced worsening on objective measures of adherence and increased parental involvement, but improved on some self- and parent-reported measures. MI participants reported improvements in quality of life and self-efficacy, but worsened well-being.
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Affiliation(s)
- E Ann Yeh
- Pediatric MS and Neuroinflammatory Disorders Program, Division of Neurology, Department of Pediatrics, Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Hospital for Sick Children, 555 University Avenue, Rm 6D33, Toronto, ON, M5G1X8, Canada.
- Faculty of Medicine, The University of Toronto, 1 King's College Circle #3172, Toronto, ON, M5S 1A8, Canada.
| | - Stephanie A Grover
- Pediatric MS and Neuroinflammatory Disorders Program, Division of Neurology, Department of Pediatrics, Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Hospital for Sick Children, 555 University Avenue, Rm 6D33, Toronto, ON, M5G1X8, Canada
| | - Victoria E Powell
- DeltaQuest Foundation Inc., 31 Mitchell Road, Concord, MA, 01742, USA
| | - Gulay Alper
- Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 4401 Penn Avenue, Pittsburgh, PA, 15224, USA
| | - Brenda L Banwell
- Division of Neurology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Kim Edwards
- Department of Psychiatry, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G1X8, Canada
| | - Mark Gorman
- Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Jennifer Graves
- University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Timothy E Lotze
- Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin Street, Houston, TX, 77030, USA
| | - Jean K Mah
- Alberta Children's Hospital, 2888 Shanganappi Trail NW, Calgary, AB, T3B 6A8, Canada
| | - Lauren Mednick
- Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Jayne Ness
- University of Alabama at Birmingham, 1720 2nd Avenue, Birmingham, AL, 35294, USA
| | - Maya Obadia
- ELLICSR: Health, Wellness, and Cancer Survivorship Centre, University Health Network, 585 University Avenue, Toronto, ON, M5G 2C4, Canada
- Department of Psychology, Faculty of Medicine, University of Toronto, 1 King's College Circle #3172, Toronto, ON, M5S 1A8, Canada
| | - Ruth Slater
- Department of Psychiatry, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G1X8, Canada
| | - Amy Waldman
- Division of Neurology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Emmanuelle Waubant
- University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Carolyn E Schwartz
- DeltaQuest Foundation Inc., 31 Mitchell Road, Concord, MA, 01742, USA
- Departments of Medicine and Orthopaedic Surgery, Tufts University Medical School, 800 Washington Street, Boston, MA, 02111, USA
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33
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Rice GI, Kitabayashi N, Barth M, Briggs TA, Burton AC, Carpanelli ML, Cerisola AM, Colson C, Dale RC, Danti FR, Darin N, De Azua B, De Giorgis V, De Goede CGL, Desguerre I, De Laet C, Eslahi A, Fahey MC, Fallon P, Fay A, Fazzi E, Gorman MP, Gowrinathan NR, Hully M, Kurian MA, Leboucq N, Lin JPSM, Lines MA, Mar SS, Maroofian R, Martí-Sanchez L, McCullagh G, Mojarrad M, Narayanan V, Orcesi S, Ortigoza-Escobar JD, Pérez-Dueñas B, Petit F, Ramsey KM, Rasmussen M, Rivier F, Rodríguez-Pombo P, Roubertie A, Stödberg TI, Toosi MB, Toutain A, Uettwiller F, Ulrick N, Vanderver A, Waldman A, Livingston JH, Crow YJ. Genetic, Phenotypic, and Interferon Biomarker Status in ADAR1-Related Neurological Disease. Neuropediatrics 2017; 48:166-184. [PMID: 28561207 PMCID: PMC5985975 DOI: 10.1055/s-0037-1601449] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We investigated the genetic, phenotypic, and interferon status of 46 patients from 37 families with neurological disease due to mutations in ADAR1. The clinicoradiological phenotype encompassed a spectrum of Aicardi-Goutières syndrome, isolated bilateral striatal necrosis, spastic paraparesis with normal neuroimaging, a progressive spastic dystonic motor disorder, and adult-onset psychological difficulties with intracranial calcification. Homozygous missense mutations were recorded in five families. We observed a p.Pro193Ala variant in the heterozygous state in 22 of 23 families with compound heterozygous mutations. We also ascertained 11 cases from nine families with a p.Gly1007Arg dominant-negative mutation, which occurred de novo in four patients, and was inherited in three families in association with marked phenotypic variability. In 50 of 52 samples from 34 patients, we identified a marked upregulation of type I interferon-stimulated gene transcripts in peripheral blood, with a median interferon score of 16.99 (interquartile range [IQR]: 10.64-25.71) compared with controls (median: 0.93, IQR: 0.57-1.30). Thus, mutations in ADAR1 are associated with a variety of clinically distinct neurological phenotypes presenting from early infancy to adulthood, inherited either as an autosomal recessive or dominant trait. Testing for an interferon signature in blood represents a useful biomarker in this context.
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Affiliation(s)
- Gillian I. Rice
- Division of Evolution and Genomic Sciences, Manchester Academic
Health Science Centre, School of Biological Sciences, Faculty of Biology, Medicine
and Health, University of Manchester, Manchester, United Kingdom
| | - Naoki Kitabayashi
- Laboratory of Neurogenetics and Neuroinflammation, INSERM UMR 1163,
Paris, France,Sorbonne-Paris-Cité, Institut Imagine, Hôpital
Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris
Descartes University, Paris, France
| | | | - Tracy A. Briggs
- Division of Evolution and Genomic Sciences, Manchester Academic
Health Science Centre, School of Biological Sciences, Faculty of Biology, Medicine
and Health, University of Manchester, Manchester, United Kingdom,Manchester Centre for Genomic Medicine, Central Manchester
University Hospitals NHS Foundation Trust, Manchester Academic Health Science
Centre, St Mary’s Hospital, Manchester, United Kingdom
| | - Annabel C.E. Burton
- Department of Paediatrics and Child Health, St George’s
University Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Alfredo M. Cerisola
- Department of Pediatric Neurology, Facultad de Medicina, UDELAR,
Montevideo, Uruguay
| | - Cindy Colson
- Clinique de Génétique, Hôpital Jeanne de
Flandre, CHU Lille, Lille, France
| | - Russell C. Dale
- Institute for Neuroscience and Muscle Research, Children’s
Hospital at Westmead, University of Sydney, Sydney, Australia
| | - Federica Rachele Danti
- Department of Developmental Neurosciences, Institute of Child
Health, UCL, London, United Kingdom,Department of Neurology, Great Ormond Street Hospital, London,
United Kingdom,Department of Paediatrics, Child Neurology and Psychiatry, Sapienza
University, Rome, Italy
| | - Niklas Darin
- Department of Pediatrics, Institute of Clinical Sciences,
Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Begoña De Azua
- Department of Pediatrics, Hospital Son Llátzer, Palma de
Mallorca, Spain
| | - Valentina De Giorgis
- Child Neurology and Psychiatry Unit, C. Mondino National
Neurological Institute, Pavia, Italy
| | | | - Isabelle Desguerre
- Department of Paediatric Neurology, Hôpital Necker-Enfants
Malades, AP-HP, Paris, France
| | - Corinne De Laet
- Nutrition and metabolic Unit, Hôpital Universitaire des
Enfants Reine Fabiola, Brussels, Belgium
| | - Atieh Eslahi
- Department of Medical Genetics, School of Medicine, Mashhad
University of Medical Sciences, Mashhad, Iran
| | - Michael C. Fahey
- Department of Paediatrics, Monash University, Melbourne,
Australia
| | - Penny Fallon
- Department of Paediatric Neurology, St George’s University
Hospitals NHS Foundation Trust, London, United Kingdom
| | - Alex Fay
- Department of Neurology, University of California, California, San
Francisco, United States
| | - Elisa Fazzi
- Unit of Child Neurology and Psychiatry, Department of Clinical and
Experimental Sciences, Civil Hospital, University of Brescia, Brescia, Italy
| | - Mark P. Gorman
- Department of Neurology, Boston Children’s Hospital,
Boston, United States
| | | | - Marie Hully
- Department of Paediatric Neurology, Hôpital Necker-Enfants
Malades, AP-HP, Paris, France
| | - Manju A. Kurian
- Department of Developmental Neurosciences, Institute of Child
Health, UCL, London, United Kingdom,Department of Neurology, Great Ormond Street Hospital, London,
United Kingdom
| | | | - Jean-Pierre S-M Lin
- General Neurology and Complex Motor Disorders Service, Evelina
Children’s Hospital, Guy’s & St Thomas’ NHS Foundation
Trust, London, United Kingdom
| | | | - Soe S. Mar
- Department of Pediatric Neurology, St. Louis Children’s
Hospital, Washington University School of Medicine, St. Louis, United States
| | - Reza Maroofian
- Medical Research, RILD Wellcome Wolfson Centre, Exeter Medical
School, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - Laura Martí-Sanchez
- Department of Child Neurology, Hospital Sant Joan de Déu,
Esplugues de Llobregat, Catalonia, Spain
| | - Gary McCullagh
- Department of Paediatric Neurology, Royal Manchester
Children’s Hospital, Manchester, United Kingdom
| | - Majid Mojarrad
- Department of Medical Genetics, School of Medicine, Mashhad
University of Medical Sciences, Mashhad, Iran
| | - Vinodh Narayanan
- Neurogenomics Division, Center for Rare Childhood Disorders, TGen
–The Translational Genomics Research Institute, Phoenix, United States
| | - Simona Orcesi
- Child Neurology and Psychiatry Unit, C. Mondino National
Neurological Institute, Pavia, Italy
| | | | - Belén Pérez-Dueñas
- Department of Child Neurology, Hospital Sant Joan de Déu,
Esplugues de Llobregat, Catalonia, Spain
| | - Florence Petit
- Clinique de Génétique, Hôpital Jeanne de
Flandre, CHU Lille, Lille, France
| | - Keri M. Ramsey
- Neurogenomics Division, Center for Rare Childhood Disorders, TGen
–The Translational Genomics Research Institute, Phoenix, United States
| | - Magnhild Rasmussen
- Department of Clinical Neurosciences for Children, and Unit for
Congenital and Hereditary Neuromuscular Disorders, Oslo University Hospital, Oslo,
Norway
| | - François Rivier
- Department of Neuropédiatrie and CR Maladies
Neuromusculaires, CHU de Montpellier, France,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214,
Montpellier, France
| | - Pilar Rodríguez-Pombo
- Centro de Diagnóstico de Enfermedades Moleculares, Centro
de Biología Molecular Severo Ochoa, Universidad Autónoma Madrid,
CIBERER, IDIPAZ, Madrid, Spain
| | - Agathe Roubertie
- Department of Neuropédiatrie and CR Maladies
Neuromusculaires, CHU de Montpellier, France,INSERM U1051, Institut des Neurosciences de Montpellier,
Montpellier, France
| | - Tommy I. Stödberg
- Neuropediatric Unit, Karolinska University Hospital, Stockholm,
Sweden
| | - Mehran Beiraghi Toosi
- Department of Pediatric Neurology, Ghaem Medical Center, School of
Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Florence Uettwiller
- Pediatric Immunology-Hematology and Rheumatology Unit, Institut
Imagine, Hôpital Necker Enfants Malades, Assistance
Publique-Hôpitaux de Paris, Paris, France,Department of Allergology and Clinical Immunology, CHRU Tours,
Tours, France
| | - Nicole Ulrick
- Department of Pediatrics, Children’s Hospital of
Philadelphia, Philadelphia, United States
| | - Adeline Vanderver
- Department of Pediatrics, Children’s Hospital of
Philadelphia, Philadelphia, United States
| | - Amy Waldman
- Department of Pediatrics, Children’s Hospital of
Philadelphia, Philadelphia, United States
| | - John H. Livingston
- Department of Paediatric Neurology, Leeds General Infirmary, Leeds,
United Kingdom
| | - Yanick J. Crow
- Division of Evolution and Genomic Sciences, Manchester Academic
Health Science Centre, School of Biological Sciences, Faculty of Biology, Medicine
and Health, University of Manchester, Manchester, United Kingdom,Laboratory of Neurogenetics and Neuroinflammation, INSERM UMR 1163,
Paris, France,Sorbonne-Paris-Cité, Institut Imagine, Hôpital
Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris
Descartes University, Paris, France
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34
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de Blank P, Berman J, Prelack M, Waldman A, Fisher M. LGG-03. EFFECT OF AGE AND NEUROFIBROMATOSIS TYPE 1 STATUS ON WHITE MATTER INTEGRITY IN THE OPTIC RADIATIONS IN CHILDREN. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox083.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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35
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Gianfrancesco MA, Stridh P, Rhead B, Shao X, Xu E, Graves JS, Chitnis T, Waldman A, Lotze T, Schreiner T, Belman A, Greenberg B, Weinstock-Guttman B, Aaen G, Tillema JM, Hart J, Caillier S, Ness J, Harris Y, Rubin J, Candee M, Krupp L, Gorman M, Benson L, Rodriguez M, Mar S, Kahn I, Rose J, Roalstad S, Casper TC, Shen L, Quach H, Quach D, Hillert J, Bäärnhielm M, Hedstrom A, Olsson T, Kockum I, Alfredsson L, Metayer C, Schaefer C, Barcellos LF, Waubant E. Evidence for a causal relationship between low vitamin D, high BMI, and pediatric-onset MS. Neurology 2017; 88:1623-1629. [PMID: 28356466 DOI: 10.1212/wnl.0000000000003849] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 01/20/2017] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To utilize Mendelian randomization to estimate the causal association between low serum vitamin D concentrations, increased body mass index (BMI), and pediatric-onset multiple sclerosis (MS) using genetic risk scores (GRS). METHODS We constructed an instrumental variable for vitamin D (vitD GRS) by computing a GRS for 3 genetic variants associated with levels of 25(OH)D in serum using the estimated effect of each risk variant. A BMI GRS was also created that incorporates the cumulative effect of 97 variants associated with BMI. Participants included non-Hispanic white individuals recruited from over 15 sites across the United States (n = 394 cases, 10,875 controls) and Sweden (n = 175 cases, 5,376 controls; total n = 16,820). RESULTS Meta-analysis findings demonstrated that a vitD GRS associated with increasing levels of 25(OH)D in serum decreased the odds of pediatric-onset MS (odds ratio [OR] 0.72, 95% confidence interval [CI] 0.55, 0.94; p = 0.02) after controlling for sex, genetic ancestry, HLA-DRB1*15:01, and over 100 non-human leukocyte antigen MS risk variants. A significant association between BMI GRS and pediatric disease onset was also demonstrated (OR 1.17, 95% CI 1.05, 1.30; p = 0.01) after adjusting for covariates. Estimates for each GRS were unchanged when considered together in a multivariable model. CONCLUSIONS We provide evidence supporting independent and causal effects of decreased vitamin D levels and increased BMI on susceptibility to pediatric-onset MS.
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Affiliation(s)
- Milena A Gianfrancesco
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Pernilla Stridh
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Brooke Rhead
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Xiaorong Shao
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Edison Xu
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Jennifer S Graves
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Tanuja Chitnis
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Amy Waldman
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Timothy Lotze
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Teri Schreiner
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Anita Belman
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Benjamin Greenberg
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Bianca Weinstock-Guttman
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Gregory Aaen
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Jan M Tillema
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Janace Hart
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Stacy Caillier
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Jayne Ness
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Yolanda Harris
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Jennifer Rubin
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Meghan Candee
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Lauren Krupp
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Mark Gorman
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Leslie Benson
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Moses Rodriguez
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Soe Mar
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Ilana Kahn
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - John Rose
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Shelly Roalstad
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - T Charles Casper
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Ling Shen
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Hong Quach
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Diana Quach
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Jan Hillert
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Maria Bäärnhielm
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Anna Hedstrom
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Tomas Olsson
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Ingrid Kockum
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Lars Alfredsson
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Catherine Metayer
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Catherine Schaefer
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Lisa F Barcellos
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA
| | - Emmanuelle Waubant
- From the Division of Epidemiology, School of Public Health (M.A.G., X.S., E.X., H.Q., D.Q., C.M., L.F.B.), and Computational Biology Graduate Group (B.R.), University of California, Berkeley; Department of Clinical Neuroscience and Center for Molecular Medicine (P.S.), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Department of Neurology (J.S.G., E.W.) and Regional Pediatric MS Center, Neurology (J.H., S.C.), University of California, San Francisco; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Blue Bird Circle Multiple Sclerosis Center (T.L.), Baylor College of Medicine, Houston, TX; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Lourie Center for Pediatric Multiple Sclerosis (A.B., L.K.), Stony Brook Children's Hospital, NY; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Mayo Clinic's Pediatric Multiple Sclerosis Center (J.M.T., M.R.), Rochester, MN; University of Alabama Center for Pediatric-onset Demyelinating Disease (J.N., Y.H.), Children's Hospital of Alabama, Birmingham; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Boston Children's Hospital (M.G., L.B.), MA; Pediatric-onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Children's National Medical Center (I.K.), Washington, DC; Departments of Neurology (J.R.) and Pediatrics (S.R., T.C.C.), University of Utah School of Medicine, Salt Lake City; Kaiser Permanente Division of Research (L.S., C.S., L.F.B.), Oakland, CA; Institute of Environmental Medicine (J.H., M.B., A.H., T.O., I.K., L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Stockholm County Council, Stockholm, Sweden; and Research Program on Genes, Environment and Health (C.S.), Kaiser Permanente, Oakland, CA.
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Bourne T, Waltz M, Casper TC, Kavak K, Aaen G, Belman A, Benson L, Candee M, Chitnis T, Graves J, Greenberg B, Gorman M, Harris Y, Krupp L, Lotze T, Mar S, Ness J, Olsen C, Roalstad S, Rodriguez M, Rose J, Rubin J, Schreiner T, Tillema JM, Kahn I, Waldman A, Barcellos L, Waubant E, Weinstock-Guttman B. Evaluating the association of allergies with multiple sclerosis susceptibility risk and disease activity in a pediatric population. J Neurol Sci 2017; 375:371-375. [PMID: 28320170 DOI: 10.1016/j.jns.2017.02.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 02/16/2017] [Accepted: 02/17/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) and allergies are both considered to be related to imbalanced Th1 and Th2 immune responses. Previous studies evaluating the relationship between MS and allergies provide conflicting results. OBJECTIVE To assess allergies and asthma as risk factors for MS and as predictors of MS relapses in a pediatric cohort. METHODS The environment and genetic risk factors for pediatric MS study is a national case-control project with 16 participating US sites. An environmental questionnaire is used that includes history of allergies in the first five years of life. Case-control data are entered in the pediatric MS Network database and cases at 12 of the 16 sites enter relapse data prospectively. Annualized relapse rate was calculated for patients with follow-up and adjusted for age at disease onset, gender, race, ethnicity, and use of disease-modifying therapy (DMT). RESULTS We included 271 cases (mean age at disease onset of 15.7years and 62% female) and 418 controls. Relapse data were available for 193 cases. There was no difference in prevalence of allergies or asthma between cases and controls. Patients with food allergies had fewer relapses compared to patients without food allergies (0.14 vs 0.48, p=0.01). CONCLUSIONS While allergies and asthma are not associated with pediatric MS, cases with food allergies have fewer relapses compared to those without food allergies.
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Affiliation(s)
| | | | - T C Casper
- University of Utah, Pediatrics, United States
| | - K Kavak
- State University of New York, Neurology, United States
| | - G Aaen
- Loma Linda University, Neurology, United States
| | - A Belman
- SUNY Stony Brook, Neurology, United States
| | - L Benson
- Massachusetts General Hospital, Partners Pediatric Multiple Sclerosis Center, United States
| | - M Candee
- University of Utah, Pediatrics, United States
| | - T Chitnis
- Brigham and Women's Hospital, Neurology, United States
| | - J Graves
- Multiple Sclerosis Center, University of California, San Francisco, CA, United States
| | - B Greenberg
- University of Texas Southwestern, Neurology, United States
| | - M Gorman
- Massachusetts General Hospital, Partners Pediatric Multiple Sclerosis Center, United States
| | - Y Harris
- University of Alabama at Birmingham, Pediatrics, United States
| | - L Krupp
- SUNY Stony Brook, Neurology, United States
| | - T Lotze
- Texas Children's Hospital, Child Neurology, United States
| | - S Mar
- Washington University St. Louis, Neurology, United States
| | - J Ness
- University of Alabama at Birmingham, Pediatrics, United States
| | - C Olsen
- University of Utah, Pediatrics, United States
| | - S Roalstad
- University of Utah, Pediatrics, United States
| | | | - J Rose
- University of Utah, Neurology, United States
| | - J Rubin
- Ann & Robert Lurie Children's Hospital of Chicago, Neurology, United States
| | - T Schreiner
- University of Colorado School of Medicine, Neurology, United States
| | | | - I Kahn
- Children's National Medical Center, Washington, United States
| | - A Waldman
- Children's Hospital of Philadelphia, Neurology, United States
| | - L Barcellos
- University of California Berkeley, United States
| | - E Waubant
- Multiple Sclerosis Center, University of California, San Francisco, CA, United States
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Schwartz CE, Grover SA, Powell VE, Noguera A, Mah JK, Mar S, Mednick L, Banwell BL, Alper G, Rensel M, Gorman M, Waldman A, Schreiner T, Waubant E, Yeh EA. Risk factors for non-adherence to disease-modifying therapy in pediatric multiple sclerosis. Mult Scler 2017; 24:175-185. [PMID: 28273780 DOI: 10.1177/1352458517695469] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Adherence to disease-modifying therapies (DMTs) in pediatric multiple sclerosis (MS) is not well understood. We examined the prevalence and risk factors for poor adherence in pediatric MS. METHODS This cross-sectional study recruited youth with MS from 12 North American pediatric MS clinics. In addition to pharmacy-refill data, patients and parents completed self-report measures of adherence and quality of life. Additionally, patients completed measures of self-efficacy and well-being. Factor analysis and linear regression methods were used. RESULTS A total of 66 youth (mean age, 15.7 years) received MS DMTs (33% oral, 66% injectable). Estimates of poor adherence (i.e. missing >20% of doses) varied by source: pharmacy 7%, parent 14%, and patient 41%. Factor analysis yielded two composites: adherence summary and parental involvement in adherence. Regressions revealed that patients with better self-reported physical functioning were more adherent. Parents were more likely to be involved in adherence when their child had worse parent-reported PedsQL School Functioning and lower MS Self-Efficacy Control. Oral DMTs were associated with lesser parental involvement in adherence. CONCLUSION Rates of non-adherence varied by information source. Better self-reported physical functioning was the strongest predictor of adherence. Parental involvement in adherence was associated with worse PedsQL School Functioning and lower MS Self-Efficacy-measured confidence in controlling MS.
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Affiliation(s)
- Carolyn E Schwartz
- DeltaQuest Foundation, Inc., Concord, MA, USA/Departments of Medicine and Orthopaedic Surgery, School of Medicine, Tufts University, Boston, MA, USA
| | - Stephanie A Grover
- Department of Neuroscience and Mental Health, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Austin Noguera
- Hospital for Sick Children, Toronto, ON, Canada/Division of Neurology and Division of Neuroscience and Mental Health, Department of Pediatrics, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - Jean K Mah
- Division of Neurology, Department of Pediatrics, Cumming School of Medicine, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Soe Mar
- Departments of Neurology and Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Lauren Mednick
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brenda L Banwell
- Division of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gulay Alper
- Division of Child Neurology, Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary Rensel
- Department of Neurology, The Mellen Center, Cleveland Clinic, Cleveland, OH, USA
| | - Mark Gorman
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Amy Waldman
- Division of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Teri Schreiner
- Departments of Neurology and Pediatrics, University of Colorado Denver, Denver, CO, USA
| | - Emmanuelle Waubant
- Department of Neurology, University of San Francisco, San Francisco, CA, USA
| | - E Ann Yeh
- Division of Neurology and Department of Neuroscience and Mental Health, Department of Pediatrics, Research Institute, Hospital for Sick Children, Toronto, ON, Canada/Faculty of Medicine, The University of Toronto, Toronto, ON, Canada
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Kalk NJ, Guo Q, Owen D, Cherian R, Erritzoe D, Gilmour A, Ribeiro AS, McGonigle J, Waldman A, Matthews P, Cavanagh J, McInnes I, Dar K, Gunn R, Rabiner EA, Lingford-Hughes AR. Decreased hippocampal translocator protein (18 kDa) expression in alcohol dependence: a [ 11C]PBR28 PET study. Transl Psychiatry 2017; 7:e996. [PMID: 28072413 PMCID: PMC5545729 DOI: 10.1038/tp.2016.264] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 11/02/2016] [Accepted: 11/13/2016] [Indexed: 01/05/2023] Open
Abstract
Repeated withdrawal from alcohol is clinically associated with progressive cognitive impairment. Microglial activation occurring during pre-clinical models of alcohol withdrawal is associated with learning deficits. We investigated whether there was microglial activation in recently detoxified alcohol-dependent patients (ADP), using [11C]PBR28 positron emission tomography (PET), selective for the 18kDa translocator protein (TSPO) highly expressed in activated microglia and astrocytes. We investigated the relationship between microglial activation and cognitive performance. Twenty healthy control (HC) subjects (45±13; M:F 14:6) and nine ADP (45±6, M:F 9:0) were evaluated. Dynamic PET data were acquired for 90 min following an injection of 331±15 MBq [11C]PBR28. Regional volumes of distribution (VT) for regions of interest (ROIs) identified a priori were estimated using a two-tissue compartmental model with metabolite-corrected arterial plasma input function. ADP had an ~20% lower [11C]PBR28 VT, in the hippocampus (F(1,24) 5.694; P=0.025), but no difference in VT in other ROIs. Hippocampal [11C]PBR28 VT was positively correlated with verbal memory performance in a combined group of HC and ADP (r=0.720, P<0.001), an effect seen in HC alone (r=0.738; P=0.001) but not in ADP. We did not find evidence for increased microglial activation in ADP, as seen pre-clinically. Instead, our findings suggest lower glial density or an altered activation state with lower TSPO expression. The correlation between verbal memory and [11C]PBR28 VT, raises the possibility that abnormalities of glial function may contribute to cognitive impairment in ADP.
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Affiliation(s)
- N J Kalk
- National Addictions Centre, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK,National Addictions Centre, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 4 Windsor Walk, London SE5 8BB, UK. E-mail:
| | - Q Guo
- Neuroimaging Department, Kings College London, London, UK,Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - D Owen
- Division of Brain Sciences, Imperial College London, London, UK
| | - R Cherian
- West London Mental Health NHS Trust, London, UK
| | - D Erritzoe
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - A Gilmour
- Centre for Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | - A S Ribeiro
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - J McGonigle
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - A Waldman
- Division of Brain Sciences, Imperial College London, London, UK
| | - P Matthews
- Division of Brain Sciences, Imperial College London, London, UK
| | - J Cavanagh
- Institute of Health and Well-being, University of Glasgow, Glasgow, UK
| | - I McInnes
- Centre for Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | - K Dar
- Central and North West London NHS Trust, London, UK
| | - R Gunn
- Imanova Limited, London, UK
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Limbrick-Oldfield EH, Mick I, Cocks RE, McGonigle J, Sharman SP, Goldstone AP, Stokes PRA, Waldman A, Erritzoe D, Bowden-Jones H, Nutt D, Lingford-Hughes A, Clark L. Neural substrates of cue reactivity and craving in gambling disorder. Transl Psychiatry 2017; 7:e992. [PMID: 28045460 PMCID: PMC5545724 DOI: 10.1038/tp.2016.256] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 09/12/2016] [Accepted: 10/15/2016] [Indexed: 12/12/2022] Open
Abstract
Cue reactivity is an established procedure in addictions research for examining the subjective experience and neural basis of craving. This experiment sought to quantify cue-related brain responses in gambling disorder using personally tailored cues in conjunction with subjective craving, as well as a comparison with appetitive non-gambling stimuli. Participants with gambling disorder (n=19) attending treatment and 19 controls viewed personally tailored blocks of gambling-related cues, as well as neutral cues and highly appetitive (food) images during a functional magnetic resonance imaging (fMRI) scan performed ~2-3 h after a usual meal. fMRI analysis examined cue-related brain activity, cue-related changes in connectivity and associations with block-by-block craving ratings. Craving ratings in the participants with gambling disorder increased following gambling cues compared with non-gambling cues. fMRI analysis revealed group differences in left insula and anterior cingulate cortex, with the gambling disorder group showing greater reactivity to the gambling cues, but no differences to the food cues. In participants with gambling disorder, craving to gamble correlated positively with gambling cue-related activity in the bilateral insula and ventral striatum, and negatively with functional connectivity between the ventral striatum and the medial prefrontal cortex. Gambling cues, but not food cues, elicit increased brain responses in reward-related circuitry in individuals with gambling disorder (compared with controls), providing support for the incentive sensitization theory of addiction. Activity in the insula co-varied with craving intensity, and may be a target for interventions.
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Affiliation(s)
- E H Limbrick-Oldfield
- Centre for Gambling Research at UBC, Department of Psychology, University of British Columbia, Vancouver, BC, Canada,Department of Psychology, University of Cambridge, Cambridge, UK,Centre for Gambling Research at UBC, Department of Psychology, University of British Columbia, 2136 West Mall Vancouver, Vancouver, BC V6T 1Z4, Canada. E-mail:
| | - I Mick
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - R E Cocks
- Department of Psychology, University of Cambridge, Cambridge, UK,Centre for Neuropsychopharmacology, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - J McGonigle
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - S P Sharman
- Department of Psychology, University of Cambridge, Cambridge, UK,School of Psychology, College of Social Science, University of Lincoln, Lincoln, UK
| | - A P Goldstone
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK,Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, London, UK
| | - P R A Stokes
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, King’s College London, London, UK
| | - A Waldman
- Division of Experimental Medicine, Department of Imaging, Imperial College London, London, UK
| | - D Erritzoe
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - H Bowden-Jones
- National Problem Gambling Clinic, CNWL NHS Foundation Trust, Imperial College London, London, UK
| | - D Nutt
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - A Lingford-Hughes
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK,Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, London, UK,National Problem Gambling Clinic, CNWL NHS Foundation Trust, Imperial College London, London, UK
| | - L Clark
- Centre for Gambling Research at UBC, Department of Psychology, University of British Columbia, Vancouver, BC, Canada,Department of Psychology, University of Cambridge, Cambridge, UK
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Nourbakhsh B, Graves J, Casper TC, Lulu S, Waldman A, Belman A, Greenberg B, Weinstock-Guttman B, Aaen G, Tillema JM, Hart J, Ness J, Rubin J, Krupp L, Gorman M, Benson L, Rodriguez M, Chitnis T, Rose J, Barcellos L, Waubant E. Dietary salt intake and time to relapse in paediatric multiple sclerosis. J Neurol Neurosurg Psychiatry 2016; 87:1350-1353. [PMID: 27343226 PMCID: PMC5370574 DOI: 10.1136/jnnp-2016-313410] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/09/2016] [Accepted: 06/05/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Salt intake was reported to be associated with increased clinical and MRI activity in adult patients with relapsing-remitting multiple sclerosis (MS). OBJECTIVE To determine if salt intake is associated with time to relapse in patients with paediatric-onset MS. METHODS Paediatric-onset MS and patients with clinically isolated syndrome (CIS) within 4 years of disease onset were recruited from 15 paediatric MS centres in the USA as part of a case-control study. Patients with available prospective relapse data subsequent to enrolment were included in this project. Dietary sodium intake was assessed by self-report questionnaire using the validated Block Kids Food Screener. Cox proportional-hazards regression models were employed to determine the association of sodium density, excess sodium intake and sodium density tertiles with time to relapse following study enrolment, adjusting for several confounders. RESULTS 174 relapsing-remitting MS/CIS patients were included in this analysis (mean age of 15.0 years, and 64.9% females). Median duration of follow-up was 1.8 years. In an unadjusted analysis, density of daily sodium intake was not associated with time to relapse, and patients with excess sodium intake had no decrease in time to relapse as compared with patients with non-excess sodium intake. The multivariable analysis demonstrated that patients in the medium and high tertile of sodium density had a HR of 0.69 (95% CI 0.37 to 1.30, p=0.25) and 1.37 (95% CI 0.74 to 2.51, p=0.32) compared with patients in the lowest tertile, respectively. CONCLUSIONS Higher salt intake was not associated with decreased time to relapse in patients with paediatric-onset MS.
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Affiliation(s)
| | - Jennifer Graves
- UCSF Regional Paediatric MS Center, San Francisco, California, USA
| | - T Charles Casper
- Department of Paediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Sabeen Lulu
- UCSF Regional Paediatric MS Center, San Francisco, California, USA
| | - Amy Waldman
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anita Belman
- Department of Neurology, SUNY Stony Brook, Stony Brook, New York, USA
| | | | | | - Gregory Aaen
- Department of Child Neurology, Loma Linda University, Loma Linda, California, USA
| | | | - Janace Hart
- UCSF Regional Paediatric MS Center, San Francisco, California, USA
| | - Jayne Ness
- Alabama Paediatric MS Center, Birmingham, Alabama, USA
| | - Jennifer Rubin
- Department of Paediatric Neurology, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lauren Krupp
- Department of Neurology, New York University, New York, New York, USA
| | - Mark Gorman
- Partners Paediatric MS Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Leslie Benson
- Partners Paediatric MS Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Moses Rodriguez
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Tanuja Chitnis
- Partners Paediatric MS Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John Rose
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Lisa Barcellos
- Department of Epidemiology, UC Berkeley, Berkeley, California, USA
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Chitnis T, Graves J, Weinstock-Guttman B, Belman A, Olsen C, Misra M, Aaen G, Benson L, Candee M, Gorman M, Greenberg B, Krupp L, Lotze T, Mar S, Ness J, Rose J, Rubin J, Schreiner T, Tillema J, Waldman A, Rodriguez M, Casper C, Waubant E. Distinct effects of obesity and puberty on risk and age at onset of pediatric MS. Ann Clin Transl Neurol 2016; 3:897-907. [PMID: 28097202 PMCID: PMC5224818 DOI: 10.1002/acn3.365] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/13/2016] [Accepted: 09/02/2016] [Indexed: 12/15/2022] Open
Abstract
Objective The aim of this study was to examine the relative contributions of body mass index (BMI) and pubertal measures for risk and age of onset of pediatric MS. Methods Case–control study of 254 (63% female) MS cases (onset<18 years of age) and 420 (49% female) controls conducted at 14 U.S. Pediatric MS Centers. Sex‐ and age‐stratified BMI percentiles were calculated using CDC growth charts from height and weight measured at enrollment for controls, and within 1 year of onset for MS cases. Sex‐stratified associations between MS risk and age at symptom onset with both BMI and pubertal factors were estimated controlling for race and ethnicity. Results Only 11% of girls and 15% of boys were prepubertal (Tanner stage I) at MS onset. 80% of girls had onset of MS after menarche. BMI percentiles were higher in MS cases versus controls (girls: P < 0.001; boys: P = 0.018). BMI was associated with odds of MS in multivariate models in postpubertal girls (OR = 1.60, 95% confidence interval [CI]: 1.12, 2.27, P = 0.009) and boys (OR = 1.43, 95% CI: 1.08, 1.88, P = 0.011). In girls with MS onset after menarche, higher BMI was associated with younger age at first symptoms (P = 0.031). Younger menarche was associated with stronger effects of BMI through mediation and interaction analysis. In pubertal/postpubertal boys, 89% of whom were obese/overweight, earlier sexual maturity was associated with earlier onset of MS (P < 0.001). Interpretation Higher BMI in early adolescence is a risk factor for MS in girls and boys. Earlier age at sexual maturity contributes to earlier age at MS onset, particularly in association with obesity.
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Affiliation(s)
- Tanuja Chitnis
- Partners Pediatric Multiple Sclerosis Center Massachusetts General Hospital for Children Boston Massachusetts
| | - Jennifer Graves
- Department of Neurology University of California San Francisco California
| | | | - Anita Belman
- Lourie Center for Pediatric MS Stony Brook Children's Hospital Stonybrook New York
| | - Cody Olsen
- Department of Pediatrics University of Utah Salt Lake City Utah
| | - Madhusmita Misra
- Department of Pediatric Endocrinology Massachusetts General Hospital for Children Boston Massachusetts
| | - Gregory Aaen
- Pediatric MS Center at Loma Linda University Children's Hospital Loma Linda California
| | | | - Meghan Candee
- University of Utah/Primary Children's Hospital Salt Lake City Utah
| | - Mark Gorman
- Boston Children's Hospital Boston Massachusetts
| | | | - Lauren Krupp
- Lourie Center for Pediatric MS Stony Brook Children's Hospital Stonybrook New York
| | - Timothy Lotze
- Blue Bird Circle Multiple Sclerosis Center Baylor College of Medicine Houston Texas
| | - Soe Mar
- Pediatric Onset Demyelinating Diseases and Autoimmune Encephalitis Center St. Louis Children's Hospital Washington University School of Medicine St. Louis Missouri
| | - Jayne Ness
- University of Alabama Center for Pediatric Onset Demyelinating Disease Children's Hospital of Alabama Birmingham Alabama
| | - John Rose
- Department of Neurology University of Utah Salt Lake City Utah
| | - Jennifer Rubin
- Department of Pediatric Neurology Northwestern Feinberg School of Medicine Chicago Illinois
| | - Teri Schreiner
- Children's Hospital Colorado University of Colorado Denver Colorado
| | - Jan Tillema
- Mayo Clinic's Pediatric MS Center Rochester Minnesota
| | - Amy Waldman
- Department of Neurology University of Pennsylvania Philadelphia Pennsylvania
| | | | - Charlie Casper
- Department of Pediatrics University of Utah Salt Lake City Utah
| | - Emmanuelle Waubant
- Department of Neurology University of California San Francisco California; Department of Pediatrics Benioff Children's Hospital University of California San Francisco California
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42
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Pache F, Zimmermann H, Mikolajczak J, Schumacher S, Lacheta A, Oertel FC, Bellmann-Strobl J, Jarius S, Wildemann B, Reindl M, Waldman A, Soelberg K, Asgari N, Ringelstein M, Aktas O, Gross N, Buttmann M, Ach T, Ruprecht K, Paul F, Brandt AU. MOG-IgG in NMO and related disorders: a multicenter study of 50 patients. Part 4: Afferent visual system damage after optic neuritis in MOG-IgG-seropositive versus AQP4-IgG-seropositive patients. J Neuroinflammation 2016; 13:282. [PMID: 27802824 PMCID: PMC5088645 DOI: 10.1186/s12974-016-0720-6] [Citation(s) in RCA: 176] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 09/09/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Antibodies against myelin oligodendrocyte glycoprotein (MOG-IgG) have been reported in patients with aquaporin-4 antibody (AQP4-IgG)-negative neuromyelitis optica spectrum disorders (NMOSD). The objective of this study was to describe optic neuritis (ON)-induced neuro-axonal damage in the retina of MOG-IgG-positive patients in comparison with AQP4-IgG-positive NMOSD patients. METHODS Afferent visual system damage following ON was bilaterally assessed in 16 MOG-IgG-positive patients with a history of ON and compared with that in 16 AQP4-IgG-positive NMOSD patients. In addition, 16 healthy controls matched for age, sex, and disease duration were analyzed. Study data included ON history, retinal optical coherence tomography, visual acuity, and visual evoked potentials. RESULTS Eight MOG-IgG-positive patients had a previous diagnosis of AQP4-IgG-negative NMOSD with ON and myelitis, and eight of (mainly recurrent) ON. Twenty-nine of the 32 eyes of the MOG-IgG-positive patients had been affected by at least one episode of ON. Peripapillary retinal nerve fiber layer thickness (pRNFL) and ganglion cell and inner plexiform layer volume (GCIP) were significantly reduced in ON eyes of MOG-IgG-positive patients (pRNFL = 59 ± 23 μm; GCIP = 1.50 ± 0.34 mm3) compared with healthy controls (pRNFL = 99 ± 6 μm, p < 0.001; GCIP = 1.97 ± 0.11 mm3, p < 0.001). Visual acuity was impaired in eyes after ON in MOG-IgG-positive patients (0.35 ± 0.88 logMAR). There were no significant differences in any structural or functional visual parameters between MOG-IgG-positive and AQP4-IgG-positive patients (pRNFL: 59 ± 21 μm; GCIP: 1.41 ± 0.27 mm3; Visual acuity = 0.72 ± 1.09 logMAR). Importantly, MOG-IgG-positive patients had a significantly higher annual ON relapse rate than AQP4-IgG-positive patients (median 0.69 vs. 0.29 attacks/year, p = 0.004), meaning that on average a single ON episode caused less damage in MOG-IgG-positive than in AQP4-IgG-positive patients. pRNFL and GCIP loss correlated with the number of ON episodes in MOG-IgG-positive patients (p < 0.001), but not in AQP4-IgG-positive patients. CONCLUSIONS Retinal neuro-axonal damage and visual impairment after ON in MOG-IgG-positive patients are as severe as in AQP4-IgG-positive NMOSD patients. In MOG-IgG-positive patients, damage accrual may be driven by higher relapse rates, whereas AQP4-IgG-positive patients showed fewer but more severe episodes of ON. Given the marked damage in some of our MOG-IgG-positive patients, early diagnosis and timely initiation and close monitoring of immunosuppressive therapy are important.
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Affiliation(s)
- Florence Pache
- NeuroCure Clinical Research Center (NCRC), Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Hanna Zimmermann
- NeuroCure Clinical Research Center (NCRC), Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Janine Mikolajczak
- NeuroCure Clinical Research Center (NCRC), Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sophie Schumacher
- NeuroCure Clinical Research Center (NCRC), Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Anna Lacheta
- NeuroCure Clinical Research Center (NCRC), Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Frederike C. Oertel
- NeuroCure Clinical Research Center (NCRC), Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Judith Bellmann-Strobl
- NeuroCure Clinical Research Center (NCRC), Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Brigitte Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Markus Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Amy Waldman
- Division of Neurology, Children’s Hospital of Philadelphia, Pennsylvania, USA
| | - Kerstin Soelberg
- Department of Neurology, Vejle Hospital, Vejle, Denmark
- Department of Neurobiology, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Nasrin Asgari
- Department of Neurology, Vejle Hospital, Vejle, Denmark
- Department of Neurobiology, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Nikolai Gross
- Department of Ophthalmology, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Mathias Buttmann
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Thomas Ach
- Department of Ophthalmology, University of Würzburg, Würzburg, Germany
| | - Klemens Ruprecht
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center (NCRC), Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander U. Brandt
- NeuroCure Clinical Research Center (NCRC), Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - in cooperation with the Neuromyelitis Optica Study Group (NEMOS)
- NeuroCure Clinical Research Center (NCRC), Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Division of Neurology, Children’s Hospital of Philadelphia, Pennsylvania, USA
- Department of Neurology, Vejle Hospital, Vejle, Denmark
- Department of Neurobiology, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
- Department of Neurology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- Department of Ophthalmology, Medical Faculty, University of Freiburg, Freiburg, Germany
- Department of Neurology, University of Würzburg, Würzburg, Germany
- Department of Ophthalmology, University of Würzburg, Würzburg, Germany
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité – Universitätsmedizin Berlin, Berlin, Germany
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43
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Wassmer E, Chitnis T, Pohl D, Amato MP, Banwell B, Ghezzi A, Hintzen RQ, Krupp LB, Makhani N, Rostásy K, Tardieu M, Tenembaum S, Waldman A, Waubant E, Kornberg AJ. International Pediatric MS Study Group Global Members Symposium report. Neurology 2016; 87:S110-6. [PMID: 27572855 PMCID: PMC10688073 DOI: 10.1212/wnl.0000000000002880] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 03/28/2016] [Indexed: 11/15/2022] Open
Abstract
The International Pediatric Multiple Sclerosis Study Group held its inaugural educational program, "The World of Pediatric MS: A Global Update," in September 2014 to discuss advances and challenges in the diagnosis and management of pediatric multiple sclerosis (MS) and other neuroinflammatory CNS disorders. Highlights included a discussion on the revised diagnostic criteria, which enable the differentiation of MS, acute disseminated encephalomyelitis, neuromyelitis optica, and other neuroinflammatory disorders. While these criteria currently identify clinical and MRI features for a particular diagnosis, advances in biomarkers may prove to be useful in the future. An update was also provided on environmental factors associated with pediatric MS risk and possibly outcomes, notably vitamin D deficiency. However, optimal vitamin D intake and its role in altering MS course in children have yet to be established. Regarding MS outcomes, our understanding of the cognitive consequences of early-onset MS has grown. However, further work is needed to define the course of cognitive function and its long-term outcome in diverse patient samples and to develop strategies for effective cognitive rehabilitation specifically tailored to children and adolescents. Finally, treatment strategies were discussed, including a need to consider additional drug treatment options and paradigms (escalation vs induction), although treatment should be tailored to the individual child. Of critical importance, clinical trials of newer MS agents in children are required. Although our understanding of childhood MS has improved, further research is needed to have a positive impact for children and their families.
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Affiliation(s)
- Evangeline Wassmer
- From the Department of Neurology (E. Wassmer), Birmingham Children's Hospital, UK; Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy; Division of Neurology (A.W.), Perelman School of Medicine (B.B.), The Children's Hospital of Philadelphia, University of Pennsylvania; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (R.Q.H.), MS Centre ErasMS, Erasmus MC, Rotterdam, the Netherlands; Lourie Center for Pediatric MS (L.B.K.), Stony Brook Children's, Stony Brook University, NY; Departments of Pediatrics and Neurology (N.M.), Yale University School of Medicine, New Haven, CT; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, University Witten/Herdecke, Germany; National Reference Center for Inflammatory Diseases of the Brain (M.T.), Hôpitaux Universitaires Paris-Sud, University Paris-Sud, France; Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina; Pediatric MS Center (E. Waubant), UCSF Benioff Children's Hospital, and Neurology Department, UCSF, San Francisco, CA; and the Department of Neurology (A.J.K.), Royal Children's Hospital, Parkville, Australia.
| | - Tanuja Chitnis
- From the Department of Neurology (E. Wassmer), Birmingham Children's Hospital, UK; Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy; Division of Neurology (A.W.), Perelman School of Medicine (B.B.), The Children's Hospital of Philadelphia, University of Pennsylvania; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (R.Q.H.), MS Centre ErasMS, Erasmus MC, Rotterdam, the Netherlands; Lourie Center for Pediatric MS (L.B.K.), Stony Brook Children's, Stony Brook University, NY; Departments of Pediatrics and Neurology (N.M.), Yale University School of Medicine, New Haven, CT; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, University Witten/Herdecke, Germany; National Reference Center for Inflammatory Diseases of the Brain (M.T.), Hôpitaux Universitaires Paris-Sud, University Paris-Sud, France; Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina; Pediatric MS Center (E. Waubant), UCSF Benioff Children's Hospital, and Neurology Department, UCSF, San Francisco, CA; and the Department of Neurology (A.J.K.), Royal Children's Hospital, Parkville, Australia
| | - Daniela Pohl
- From the Department of Neurology (E. Wassmer), Birmingham Children's Hospital, UK; Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy; Division of Neurology (A.W.), Perelman School of Medicine (B.B.), The Children's Hospital of Philadelphia, University of Pennsylvania; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (R.Q.H.), MS Centre ErasMS, Erasmus MC, Rotterdam, the Netherlands; Lourie Center for Pediatric MS (L.B.K.), Stony Brook Children's, Stony Brook University, NY; Departments of Pediatrics and Neurology (N.M.), Yale University School of Medicine, New Haven, CT; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, University Witten/Herdecke, Germany; National Reference Center for Inflammatory Diseases of the Brain (M.T.), Hôpitaux Universitaires Paris-Sud, University Paris-Sud, France; Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina; Pediatric MS Center (E. Waubant), UCSF Benioff Children's Hospital, and Neurology Department, UCSF, San Francisco, CA; and the Department of Neurology (A.J.K.), Royal Children's Hospital, Parkville, Australia
| | - Maria Pia Amato
- From the Department of Neurology (E. Wassmer), Birmingham Children's Hospital, UK; Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy; Division of Neurology (A.W.), Perelman School of Medicine (B.B.), The Children's Hospital of Philadelphia, University of Pennsylvania; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (R.Q.H.), MS Centre ErasMS, Erasmus MC, Rotterdam, the Netherlands; Lourie Center for Pediatric MS (L.B.K.), Stony Brook Children's, Stony Brook University, NY; Departments of Pediatrics and Neurology (N.M.), Yale University School of Medicine, New Haven, CT; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, University Witten/Herdecke, Germany; National Reference Center for Inflammatory Diseases of the Brain (M.T.), Hôpitaux Universitaires Paris-Sud, University Paris-Sud, France; Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina; Pediatric MS Center (E. Waubant), UCSF Benioff Children's Hospital, and Neurology Department, UCSF, San Francisco, CA; and the Department of Neurology (A.J.K.), Royal Children's Hospital, Parkville, Australia
| | - Brenda Banwell
- From the Department of Neurology (E. Wassmer), Birmingham Children's Hospital, UK; Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy; Division of Neurology (A.W.), Perelman School of Medicine (B.B.), The Children's Hospital of Philadelphia, University of Pennsylvania; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (R.Q.H.), MS Centre ErasMS, Erasmus MC, Rotterdam, the Netherlands; Lourie Center for Pediatric MS (L.B.K.), Stony Brook Children's, Stony Brook University, NY; Departments of Pediatrics and Neurology (N.M.), Yale University School of Medicine, New Haven, CT; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, University Witten/Herdecke, Germany; National Reference Center for Inflammatory Diseases of the Brain (M.T.), Hôpitaux Universitaires Paris-Sud, University Paris-Sud, France; Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina; Pediatric MS Center (E. Waubant), UCSF Benioff Children's Hospital, and Neurology Department, UCSF, San Francisco, CA; and the Department of Neurology (A.J.K.), Royal Children's Hospital, Parkville, Australia
| | - Angelo Ghezzi
- From the Department of Neurology (E. Wassmer), Birmingham Children's Hospital, UK; Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy; Division of Neurology (A.W.), Perelman School of Medicine (B.B.), The Children's Hospital of Philadelphia, University of Pennsylvania; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (R.Q.H.), MS Centre ErasMS, Erasmus MC, Rotterdam, the Netherlands; Lourie Center for Pediatric MS (L.B.K.), Stony Brook Children's, Stony Brook University, NY; Departments of Pediatrics and Neurology (N.M.), Yale University School of Medicine, New Haven, CT; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, University Witten/Herdecke, Germany; National Reference Center for Inflammatory Diseases of the Brain (M.T.), Hôpitaux Universitaires Paris-Sud, University Paris-Sud, France; Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina; Pediatric MS Center (E. Waubant), UCSF Benioff Children's Hospital, and Neurology Department, UCSF, San Francisco, CA; and the Department of Neurology (A.J.K.), Royal Children's Hospital, Parkville, Australia
| | - Rogier Q Hintzen
- From the Department of Neurology (E. Wassmer), Birmingham Children's Hospital, UK; Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy; Division of Neurology (A.W.), Perelman School of Medicine (B.B.), The Children's Hospital of Philadelphia, University of Pennsylvania; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (R.Q.H.), MS Centre ErasMS, Erasmus MC, Rotterdam, the Netherlands; Lourie Center for Pediatric MS (L.B.K.), Stony Brook Children's, Stony Brook University, NY; Departments of Pediatrics and Neurology (N.M.), Yale University School of Medicine, New Haven, CT; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, University Witten/Herdecke, Germany; National Reference Center for Inflammatory Diseases of the Brain (M.T.), Hôpitaux Universitaires Paris-Sud, University Paris-Sud, France; Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina; Pediatric MS Center (E. Waubant), UCSF Benioff Children's Hospital, and Neurology Department, UCSF, San Francisco, CA; and the Department of Neurology (A.J.K.), Royal Children's Hospital, Parkville, Australia
| | - Lauren B Krupp
- From the Department of Neurology (E. Wassmer), Birmingham Children's Hospital, UK; Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy; Division of Neurology (A.W.), Perelman School of Medicine (B.B.), The Children's Hospital of Philadelphia, University of Pennsylvania; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (R.Q.H.), MS Centre ErasMS, Erasmus MC, Rotterdam, the Netherlands; Lourie Center for Pediatric MS (L.B.K.), Stony Brook Children's, Stony Brook University, NY; Departments of Pediatrics and Neurology (N.M.), Yale University School of Medicine, New Haven, CT; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, University Witten/Herdecke, Germany; National Reference Center for Inflammatory Diseases of the Brain (M.T.), Hôpitaux Universitaires Paris-Sud, University Paris-Sud, France; Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina; Pediatric MS Center (E. Waubant), UCSF Benioff Children's Hospital, and Neurology Department, UCSF, San Francisco, CA; and the Department of Neurology (A.J.K.), Royal Children's Hospital, Parkville, Australia
| | - Naila Makhani
- From the Department of Neurology (E. Wassmer), Birmingham Children's Hospital, UK; Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy; Division of Neurology (A.W.), Perelman School of Medicine (B.B.), The Children's Hospital of Philadelphia, University of Pennsylvania; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (R.Q.H.), MS Centre ErasMS, Erasmus MC, Rotterdam, the Netherlands; Lourie Center for Pediatric MS (L.B.K.), Stony Brook Children's, Stony Brook University, NY; Departments of Pediatrics and Neurology (N.M.), Yale University School of Medicine, New Haven, CT; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, University Witten/Herdecke, Germany; National Reference Center for Inflammatory Diseases of the Brain (M.T.), Hôpitaux Universitaires Paris-Sud, University Paris-Sud, France; Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina; Pediatric MS Center (E. Waubant), UCSF Benioff Children's Hospital, and Neurology Department, UCSF, San Francisco, CA; and the Department of Neurology (A.J.K.), Royal Children's Hospital, Parkville, Australia
| | - Kevin Rostásy
- From the Department of Neurology (E. Wassmer), Birmingham Children's Hospital, UK; Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy; Division of Neurology (A.W.), Perelman School of Medicine (B.B.), The Children's Hospital of Philadelphia, University of Pennsylvania; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (R.Q.H.), MS Centre ErasMS, Erasmus MC, Rotterdam, the Netherlands; Lourie Center for Pediatric MS (L.B.K.), Stony Brook Children's, Stony Brook University, NY; Departments of Pediatrics and Neurology (N.M.), Yale University School of Medicine, New Haven, CT; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, University Witten/Herdecke, Germany; National Reference Center for Inflammatory Diseases of the Brain (M.T.), Hôpitaux Universitaires Paris-Sud, University Paris-Sud, France; Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina; Pediatric MS Center (E. Waubant), UCSF Benioff Children's Hospital, and Neurology Department, UCSF, San Francisco, CA; and the Department of Neurology (A.J.K.), Royal Children's Hospital, Parkville, Australia
| | - Marc Tardieu
- From the Department of Neurology (E. Wassmer), Birmingham Children's Hospital, UK; Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy; Division of Neurology (A.W.), Perelman School of Medicine (B.B.), The Children's Hospital of Philadelphia, University of Pennsylvania; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (R.Q.H.), MS Centre ErasMS, Erasmus MC, Rotterdam, the Netherlands; Lourie Center for Pediatric MS (L.B.K.), Stony Brook Children's, Stony Brook University, NY; Departments of Pediatrics and Neurology (N.M.), Yale University School of Medicine, New Haven, CT; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, University Witten/Herdecke, Germany; National Reference Center for Inflammatory Diseases of the Brain (M.T.), Hôpitaux Universitaires Paris-Sud, University Paris-Sud, France; Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina; Pediatric MS Center (E. Waubant), UCSF Benioff Children's Hospital, and Neurology Department, UCSF, San Francisco, CA; and the Department of Neurology (A.J.K.), Royal Children's Hospital, Parkville, Australia
| | - Silvia Tenembaum
- From the Department of Neurology (E. Wassmer), Birmingham Children's Hospital, UK; Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy; Division of Neurology (A.W.), Perelman School of Medicine (B.B.), The Children's Hospital of Philadelphia, University of Pennsylvania; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (R.Q.H.), MS Centre ErasMS, Erasmus MC, Rotterdam, the Netherlands; Lourie Center for Pediatric MS (L.B.K.), Stony Brook Children's, Stony Brook University, NY; Departments of Pediatrics and Neurology (N.M.), Yale University School of Medicine, New Haven, CT; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, University Witten/Herdecke, Germany; National Reference Center for Inflammatory Diseases of the Brain (M.T.), Hôpitaux Universitaires Paris-Sud, University Paris-Sud, France; Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina; Pediatric MS Center (E. Waubant), UCSF Benioff Children's Hospital, and Neurology Department, UCSF, San Francisco, CA; and the Department of Neurology (A.J.K.), Royal Children's Hospital, Parkville, Australia
| | - Amy Waldman
- From the Department of Neurology (E. Wassmer), Birmingham Children's Hospital, UK; Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy; Division of Neurology (A.W.), Perelman School of Medicine (B.B.), The Children's Hospital of Philadelphia, University of Pennsylvania; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (R.Q.H.), MS Centre ErasMS, Erasmus MC, Rotterdam, the Netherlands; Lourie Center for Pediatric MS (L.B.K.), Stony Brook Children's, Stony Brook University, NY; Departments of Pediatrics and Neurology (N.M.), Yale University School of Medicine, New Haven, CT; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, University Witten/Herdecke, Germany; National Reference Center for Inflammatory Diseases of the Brain (M.T.), Hôpitaux Universitaires Paris-Sud, University Paris-Sud, France; Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina; Pediatric MS Center (E. Waubant), UCSF Benioff Children's Hospital, and Neurology Department, UCSF, San Francisco, CA; and the Department of Neurology (A.J.K.), Royal Children's Hospital, Parkville, Australia
| | - Emmanuelle Waubant
- From the Department of Neurology (E. Wassmer), Birmingham Children's Hospital, UK; Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy; Division of Neurology (A.W.), Perelman School of Medicine (B.B.), The Children's Hospital of Philadelphia, University of Pennsylvania; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (R.Q.H.), MS Centre ErasMS, Erasmus MC, Rotterdam, the Netherlands; Lourie Center for Pediatric MS (L.B.K.), Stony Brook Children's, Stony Brook University, NY; Departments of Pediatrics and Neurology (N.M.), Yale University School of Medicine, New Haven, CT; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, University Witten/Herdecke, Germany; National Reference Center for Inflammatory Diseases of the Brain (M.T.), Hôpitaux Universitaires Paris-Sud, University Paris-Sud, France; Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina; Pediatric MS Center (E. Waubant), UCSF Benioff Children's Hospital, and Neurology Department, UCSF, San Francisco, CA; and the Department of Neurology (A.J.K.), Royal Children's Hospital, Parkville, Australia
| | - Andrew J Kornberg
- From the Department of Neurology (E. Wassmer), Birmingham Children's Hospital, UK; Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy; Division of Neurology (A.W.), Perelman School of Medicine (B.B.), The Children's Hospital of Philadelphia, University of Pennsylvania; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (R.Q.H.), MS Centre ErasMS, Erasmus MC, Rotterdam, the Netherlands; Lourie Center for Pediatric MS (L.B.K.), Stony Brook Children's, Stony Brook University, NY; Departments of Pediatrics and Neurology (N.M.), Yale University School of Medicine, New Haven, CT; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, University Witten/Herdecke, Germany; National Reference Center for Inflammatory Diseases of the Brain (M.T.), Hôpitaux Universitaires Paris-Sud, University Paris-Sud, France; Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina; Pediatric MS Center (E. Waubant), UCSF Benioff Children's Hospital, and Neurology Department, UCSF, San Francisco, CA; and the Department of Neurology (A.J.K.), Royal Children's Hospital, Parkville, Australia
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Waldman A, Ness J, Pohl D, Simone IL, Anlar B, Amato MP, Ghezzi A. Pediatric multiple sclerosis: Clinical features and outcome. Neurology 2016; 87:S74-81. [PMID: 27572865 PMCID: PMC10688072 DOI: 10.1212/wnl.0000000000003028] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 07/01/2016] [Indexed: 11/15/2022] Open
Abstract
Multiple sclerosis (MS) in children manifests with a relapsing-remitting MS (RRMS) disease course. Acute relapses consist of new neurologic deficits persisting greater than 24 hours, in the absence of intercurrent illness, and occur with a higher frequency early in the disease as compared to adult-onset RRMS. Most pediatric patients with MS recover well from these early relapses, and cumulative physical disability is rare in the first 10 years of disease. Brainstem attacks, poor recovery from a single attack, and a higher frequency of attacks portend a greater likelihood of future disability. Although prospective pediatric-onset MS cohorts have been established in recent years, there remains very limited prospective data detailing the longer-term clinical outcome of pediatric-onset MS into adulthood. Whether the advent of MS therapies, and the largely off-label access to such therapies in pediatric MS, has improved prognosis is unknown. MS onset during the key formative academic years, concurrent with active cognitive maturation, is an important determinant of long-term outcome, and is discussed in detail in another article in this supplement. Finally, increasing recognition of pediatric MS worldwide, recent launch of phase III trials for new agents in the pediatric MS population, and the clear imperative to more fully appreciate health-related quality of life in pediatric MS through adulthood highlight the need for standardized, validated, and robust outcome measures.
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Affiliation(s)
- Amy Waldman
- From the Division of Neurology, Department of Pediatrics (A.W.), Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania; Department of Pediatrics (J.N.), University of Alabama at Birmingham and Children's of Alabama; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department of Basic Medical Sciences, Neurosciences and Sense Organs (I.L.S.), University of Bari, Italy; Department of Pediatric Neurology (B.A.), Hacettepe University, Ankara, Turkey; Department NEUROFARBA, Section Neurosciences (M.P.A.), University of Florence; and Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy.
| | - Jayne Ness
- From the Division of Neurology, Department of Pediatrics (A.W.), Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania; Department of Pediatrics (J.N.), University of Alabama at Birmingham and Children's of Alabama; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department of Basic Medical Sciences, Neurosciences and Sense Organs (I.L.S.), University of Bari, Italy; Department of Pediatric Neurology (B.A.), Hacettepe University, Ankara, Turkey; Department NEUROFARBA, Section Neurosciences (M.P.A.), University of Florence; and Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy
| | - Daniela Pohl
- From the Division of Neurology, Department of Pediatrics (A.W.), Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania; Department of Pediatrics (J.N.), University of Alabama at Birmingham and Children's of Alabama; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department of Basic Medical Sciences, Neurosciences and Sense Organs (I.L.S.), University of Bari, Italy; Department of Pediatric Neurology (B.A.), Hacettepe University, Ankara, Turkey; Department NEUROFARBA, Section Neurosciences (M.P.A.), University of Florence; and Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy
| | - Isabella Laura Simone
- From the Division of Neurology, Department of Pediatrics (A.W.), Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania; Department of Pediatrics (J.N.), University of Alabama at Birmingham and Children's of Alabama; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department of Basic Medical Sciences, Neurosciences and Sense Organs (I.L.S.), University of Bari, Italy; Department of Pediatric Neurology (B.A.), Hacettepe University, Ankara, Turkey; Department NEUROFARBA, Section Neurosciences (M.P.A.), University of Florence; and Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy
| | - Banu Anlar
- From the Division of Neurology, Department of Pediatrics (A.W.), Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania; Department of Pediatrics (J.N.), University of Alabama at Birmingham and Children's of Alabama; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department of Basic Medical Sciences, Neurosciences and Sense Organs (I.L.S.), University of Bari, Italy; Department of Pediatric Neurology (B.A.), Hacettepe University, Ankara, Turkey; Department NEUROFARBA, Section Neurosciences (M.P.A.), University of Florence; and Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy
| | - Maria Pia Amato
- From the Division of Neurology, Department of Pediatrics (A.W.), Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania; Department of Pediatrics (J.N.), University of Alabama at Birmingham and Children's of Alabama; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department of Basic Medical Sciences, Neurosciences and Sense Organs (I.L.S.), University of Bari, Italy; Department of Pediatric Neurology (B.A.), Hacettepe University, Ankara, Turkey; Department NEUROFARBA, Section Neurosciences (M.P.A.), University of Florence; and Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy
| | - Angelo Ghezzi
- From the Division of Neurology, Department of Pediatrics (A.W.), Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania; Department of Pediatrics (J.N.), University of Alabama at Birmingham and Children's of Alabama; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department of Basic Medical Sciences, Neurosciences and Sense Organs (I.L.S.), University of Bari, Italy; Department of Pediatric Neurology (B.A.), Hacettepe University, Ankara, Turkey; Department NEUROFARBA, Section Neurosciences (M.P.A.), University of Florence; and Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy
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Abstract
Optic neuritis (ON) is a common presenting symptom in pediatric CNS demyelinating disorders and may be associated with dramatic visual loss. Knowledge regarding clinical presentation, associated diseases, therapy, and outcomes in ON in children has grown over the past decade. These studies have shown that younger children (<10 years of age) are more likely to present with bilateral ON and older children with unilateral ON. Furthermore, studies focusing on visual recovery have shown excellent recovery of high-contrast visual acuity in the majority of children, but functional and structural studies have shown evidence of irreversible injury and functional decline after ON in children. Although randomized controlled treatment trials have not been performed in children and adolescents with ON, standard of care suggests that the use of high-dose pulse steroids is safe and likely effective. This article reviews current knowledge about the clinical presentation and management of pediatric ON, with attention to associated syndromes and evaluative tools that may inform diagnosis and interventions.
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Affiliation(s)
- E Ann Yeh
- From the Division of Neurology (E.A.Y.), Hospital for Sick Children, Hospital for Sick Children Research Institute, Department of Pediatrics, University of Toronto, Ontario, Canada; Department of Neurology (J.S.G.), University of California, San Francisco; Department of Neurology (L.A.B.), Boston Children's Hospital, Boston, MA; Department of Neurology (E.W.), Birmingham Children's Hospital, Birmingham, UK; and Department of Neurology (A.W.), The Children's Hospital of Philadelphia, PA.
| | - Jennifer S Graves
- From the Division of Neurology (E.A.Y.), Hospital for Sick Children, Hospital for Sick Children Research Institute, Department of Pediatrics, University of Toronto, Ontario, Canada; Department of Neurology (J.S.G.), University of California, San Francisco; Department of Neurology (L.A.B.), Boston Children's Hospital, Boston, MA; Department of Neurology (E.W.), Birmingham Children's Hospital, Birmingham, UK; and Department of Neurology (A.W.), The Children's Hospital of Philadelphia, PA
| | - Leslie A Benson
- From the Division of Neurology (E.A.Y.), Hospital for Sick Children, Hospital for Sick Children Research Institute, Department of Pediatrics, University of Toronto, Ontario, Canada; Department of Neurology (J.S.G.), University of California, San Francisco; Department of Neurology (L.A.B.), Boston Children's Hospital, Boston, MA; Department of Neurology (E.W.), Birmingham Children's Hospital, Birmingham, UK; and Department of Neurology (A.W.), The Children's Hospital of Philadelphia, PA
| | - Evangeline Wassmer
- From the Division of Neurology (E.A.Y.), Hospital for Sick Children, Hospital for Sick Children Research Institute, Department of Pediatrics, University of Toronto, Ontario, Canada; Department of Neurology (J.S.G.), University of California, San Francisco; Department of Neurology (L.A.B.), Boston Children's Hospital, Boston, MA; Department of Neurology (E.W.), Birmingham Children's Hospital, Birmingham, UK; and Department of Neurology (A.W.), The Children's Hospital of Philadelphia, PA
| | - Amy Waldman
- From the Division of Neurology (E.A.Y.), Hospital for Sick Children, Hospital for Sick Children Research Institute, Department of Pediatrics, University of Toronto, Ontario, Canada; Department of Neurology (J.S.G.), University of California, San Francisco; Department of Neurology (L.A.B.), Boston Children's Hospital, Boston, MA; Department of Neurology (E.W.), Birmingham Children's Hospital, Birmingham, UK; and Department of Neurology (A.W.), The Children's Hospital of Philadelphia, PA
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Ordidge K, Grech-Sollars M, Honeyfield L, Khan S, O'Neill K, Peterson D, Vaqas B, Roncaroli F, Towey D, Barwick T, Waldman A. PO2818F- FLUOROMETHYLCHOLINE (18F-FMC) PET/CT AND MAGNETIC RESONANCE SPECTROSCOPY (MRS) IMAGING AND TISSUE BIOMARKERS OF CELL MEMBRANE TURNOVER IN PRIMARY BRAIN GLIOMAS- A PILOT STUDY. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov284.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bennett JL, de Seze J, Lana-Peixoto M, Palace J, Waldman A, Schippling S, Tenembaum S, Banwell B, Greenberg B, Levy M, Fujihara K, Chan KH, Kim HJ, Asgari N, Sato DK, Saiz A, Wuerfel J, Zimmermann H, Green A, Villoslada P, Paul F. Neuromyelitis optica and multiple sclerosis: Seeing differences through optical coherence tomography. Mult Scler 2015; 21:678-88. [PMID: 25662342 PMCID: PMC4425816 DOI: 10.1177/1352458514567216] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 11/27/2014] [Indexed: 01/12/2023]
Abstract
Neuromyelitis optica (NMO) is an inflammatory autoimmune disease of the central nervous system that preferentially targets the optic nerves and spinal cord. The clinical presentation may suggest multiple sclerosis (MS), but a highly specific serum autoantibody against the astrocytic water channel aquaporin-4 present in up to 80% of NMO patients enables distinction from MS. Optic neuritis may occur in either condition resulting in neuro-anatomical retinal changes. Optical coherence tomography (OCT) has become a useful tool for analyzing retinal damage both in MS and NMO. Numerous studies showed that optic neuritis in NMO typically results in more severe retinal nerve fiber layer (RNFL) and ganglion cell layer thinning and more frequent development of microcystic macular edema than in MS. Furthermore, while patients’ RNFL thinning also occurs in the absence of optic neuritis in MS, subclinical damage seems to be rare in NMO. Thus, OCT might be useful in differentiating NMO from MS and serve as an outcome parameter in clinical studies.
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Affiliation(s)
- J L Bennett
- Departments of Neurology and Ophthalmology, University of Colorado, Denver, Colorado, USA
| | - J de Seze
- Neurology Service, University Hospital of Strasbourg, France
| | - M Lana-Peixoto
- CIEM MS Research Center, University of Minas Gerais Medical School, Belo Horizonte Brazil
| | - J Palace
- Department of Neurology, Oxford University Hospitals National Health Service Trust, Oxford, UK
| | - A Waldman
- Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, USA
| | - S Schippling
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University Hospital Zürich, Switzerland
| | - S Tenembaum
- Department of Neurology, National Pediatric Hospital Dr Juan P. Garrahan, Buenos Aires, Argentina
| | - B Banwell
- Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, USA
| | - B Greenberg
- Departments of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas, Texas, USA
| | - M Levy
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland USA
| | - K Fujihara
- Department of Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - K H Chan
- University Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - H J Kim
- Research Institute and Hospital of National Cancer Center Goyang Republic of Korea
| | - N Asgari
- Institute of Molecular Medicine, University of Southern Denmark, and Department of Neurology, Vejle Hospital, Odense, Denmark
| | - D K Sato
- Department of Neurology, Tohoku University School of Medicine, Sendai, Japan
| | - A Saiz
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institute of Biomedical Research August Pi Sunyer, Barcelona, Spain
| | - J Wuerfel
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, and Institute of Interventional and Diagnostic Neuroradiology, University Medicine Göttingen, Germany
| | - H Zimmermann
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Germany
| | - A Green
- Multiple Sclerosis Center, UCSF Department of Neurology and Neuro-ophthalmology Service, UCSF Department of Ophthalmology, San Francisco, USA
| | - P Villoslada
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institute of Biomedical Research August Pi Sunyer, Barcelona, Spain
| | - F Paul
- NeuroCure Clinical Research and Department of Neurology, Charité - Universitätsmedizin Berlin and Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin and Max-Delbrück-Center for Molecular Medicine, Berlin, Germany
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Waldman A, Ghezzi A, Bar-Or A, Mikaeloff Y, Tardieu M, Banwell B. Multiple sclerosis in children: an update on clinical diagnosis, therapeutic strategies, and research. Lancet Neurol 2014; 13:936-48. [PMID: 25142460 DOI: 10.1016/s1474-4422(14)70093-6] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The clinical features, diagnostic challenges, neuroimaging appearance, therapeutic options, and pathobiological research progress in childhood-and adolescent-onset multiple sclerosis have been informed by many new insights in the past 7 years. National programmes in several countries, collaborative research efforts, and an established international paediatric multiple sclerosis study group have contributed to revised clinical diagnostic definitions, identified clinical features of multiple sclerosis that differ by age of onset, and made recommendations regarding the treatment of paediatric multiple sclerosis. The relative risks conveyed by genetic and environmental factors to paediatric multiple sclerosis have been the subject of several large cohort studies. MRI features have been characterised in terms of qualitative descriptions of lesion distribution and applicability of MRI aspects to multiple sclerosis diagnostic criteria, and quantitative studies have assessed total lesion burden and the effect of the disease on global and regional brain volume. Humoral-based and cell-based assays have identified antibodies against myelin, potassium-channel proteins, and T-cell profiles that support an adult-like T-cell repertoire and cellular reactivity against myelin in paediatric patients with multiple sclerosis. Finally, the safety and efficacy of standard first-line therapies in paediatric multiple sclerosis populations are now appreciated in more detail, and consensus views on the future conduct and feasibility of phase 3 trials for new drugs have been proposed.
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Affiliation(s)
- Amy Waldman
- Division of Neurology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Angelo Ghezzi
- Ospedale di Gallarate, Centro Studi Sclerosi Multipla, Gallarate, Italy
| | - Amit Bar-Or
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Yann Mikaeloff
- Unité de Rééducation Neurologique Infantile, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marc Tardieu
- Service de Neurologie Pédiatrique, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Brenda Banwell
- Division of Neurology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
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Waldman A, Upadhyay N, Adams A, Peterson D, Roncaroli F. NI-02 * ELEVATED MYOINOSITOL IN DIFFUSE ASTROCYTOMA; A MARKER OF ANAPLASTIC PHENOTYPE, AND NOT ATTRIBUTABLE TO MICROGLIAL INFILTRATION. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou264.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mattoscio M, Nicholas R, Malik O, Dazzi F, Lee J, Waldman A, Muraro P. Differential Increase of Circulating Haematopoietic Stem Cells (HSC) Following Therapeutic alpha 4-Integrin Blockade in Multiple Sclerosis: Correlation between HSC Mobilization Status and Response to Treatment (IN8-1.006). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.in8-1.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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