Early initiation of highly effective escalation therapies in pediatric patients with multiple sclerosis (MS) is associated with reduced cognitive impairment (CI) and may prevent cognitive decline in these patients, a study in the European Journal of Paediatric Neurology suggests.

A total of 19 patients with therapy-naive or ß-interferon-treated juvenile MS (mean age, 15.05 years) were enrolled from a single center in Germany. Participants in the study completed a comprehensive neuropsychological assessment at the time of initial presentation and again at a mean follow-up period of 2.5 years. Physical disability was also assessed, and a neuropediatric examination and conventional cerebral magnetic resonance imaging (MRI) were performed.

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At baseline, 47% (n=9) of patients were considered impaired in ≥1 cognitive test (z-score <−1.645 compared with age-adjusted normative data). The highest impairment frequency was found in domains for processing speed, as well as attention and executive function.

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In patients whose therapy had not been escalated (n=13), there was a higher impairment frequency at follow-up, with 69% impaired in ≥1 test. Cognition was considered preserved or improved in patients with treatment that had been escalated to highly effective therapy, with 0% considered impaired. Patient demographics, MRI metrics, or cognitive performance at baseline did not appear to contribute to the group differences at follow-up.

Limitations of the study included the small sample size, as well as the lack of randomization to escalation and nonescalation treatment groups.

On the basis of their findings, the researchers suggest that “[c]ognitive performance may be unconnected to changes in typical clinical markers in [pediatric] MS, emphasizing the need for standardized cognitive testing as an important marker of disease burden.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Johnen A, Elpers C, Riepl E, et al. Early effective treatment may protect from cognitive decline in paediatric multiple sclerosis. Eur J Paediatr Neurol. 2019;23(6):783-791.