Health Care Utilization, Prodromal Symptoms Prior to Pediatric-Onset MS

Researchers sought to characterize health care utilization and identify and describe prodromal symptoms in patients with POMS.

In a cohort of patients with pediatric-onset multiple sclerosis (POMS), increased utilization of health care resources has been observed in the year immediately prior to their MS diagnosis — a finding that is consistent with those from prior population-based data. Further, individuals with POMS typically present with a myriad of nonneurologic complaints, including psychiatric, headache, infection, pain, sensory, and motor symptoms. These study findings were presented at the 2022 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC) held from June 1-4, in National Harbor, Maryland.

Recognizing that accumulating evidence suggests the presence of a prodromal period in MS, the researchers sought to characterize health care utilization, as well as to identify and describe prodromal symptoms, in the POMS population of patients in the 2 years leading up to their MS diagnosis. Although a variety of clinical symptoms — that is, autonomic, pain, fatigue, and psychiatric symptoms — have been shown to precede a MS diagnosis by several years among adult patients, sparse data are available in pediatric patients with MS.

The cohort study was conducted among patients who had presented to the Pediatric MS and Demyelinating Disease Center at Washington University School of Medicine, St. Louis, Missouri, and had been screened between June 2011 and June 2021. A total of 122 patients were included in the current study. Overall, 37 of these individuals were diagnosed as having MS — 24 of whom had electronic medical records (EMRs) available that were analyzed retrospectively. Data obtained included symptoms at –2 to 0 years prior to an MS diagnosis and at the time of an MS diagnosis, as well as health care utilization at –1 to 0 years and at –2 to –1 years prior to an MS diagnosis. The data collected involved ambulatory physician visits, hospital admissions, and telephone calls to physicians’ offices.

Study findings revealed that the 24 patients with available EMRs had more health care resource utilization in the year immediately leading up to a diagnosis of MS (244 health care interactions) compared with the year earlier (96 health care interactions).

In year –2 to –1, 19.8% of these interactions were neurology-related, compared with 68% in year –1 to 0. Neurologic complaints included headache in 58.3% of patients, sensory symptoms in 50.0%, visual symptoms in 62.5%, pain in 41.7%, and motor symptoms in 41.7% in the 2 years leading up to the MS diagnosis. Common nonneurologic concerns were psychiatric, infection, musculoskeletal, and dermatologic in nature. There were only 2 patients in the current study who did not use the health care system for a nonneurologic complaint.

“This is similar to prodromal symptoms identified in the adult MS population but has not previously been shown in the POMS population,” the researchers acknowledged.

This is the first time that the current findings have been demonstrated in the POMS population.


Zolno R, Schanzer N. Lewis K, et al. Prodromal symptoms and health care use in pediatric-onset multiple sclerosis before diagnosis. Presented at: CMSC 2022 Annual Meeting; June 1-4, 2022; National Harbor, Maryland. Abstract NIB04.