Citations 2
Exploring Healthcare Continuity in Pediatric‐Onset Multiple Sclerosis in the United States
Abrams, Aaron , Waltz, Michael , Race, Jonathan, Casper, T. Charles, Gambrah‐Lyles, Claudia, O’Neill, Kimberly, Wright, Melissa A. , Poisson, Kelsey E. , Bernfeld, Eva‐Chava M., Aaen, Gregory, Benson, Leslie A., Chitnis, Tanuja, Francisco, Carla, Gorman, Mark , Lotze, Timothy E., Mar, Soe, Ness, Jayne, Schreiner, Teri , Shukla, Nikita, Tillema, Jan‐Mendelt, Weinstock‐Guttman, Bianca, Wheeler, Yolanda, Waubant, Emmanuelle, Rose, John W. , Abrams, Aaron , Wright, Melissa A , Gombolay, Grace Y , Race, Jonathan , Casper, T. Charles , Gambrah-Lyles, Claudia , O'Neill, Kimberly , Virupakshaiah, Akash , Fisher, Kristen , Bernfeld, Eva Chava, Aaen, Gregory , Benson, Leslie , Chitnis, Tanuja , Francisco, Carla , Gombolay, Grace , Graves, Jennifer , Krupp, Lauren , Mar, Soe , Ness, Jayne , Rensel, Mary R. , Rodriguez, Moses , Schreiner, Teri , Tillema, Jan‐Mendelt , Weinstock‐Guttman, Bianca , Wheeler, Yolanda , Waubant, Emmanuelle L.
Annals of the Child Neurology Society | June 25, 2026 | Volume: No volume available | Issue: No issue available | Pages: No page available
ABSTRACT Objective Little is known about shifting from pediatric to adult‐focused multiple sclerosis (MS) care. This study aims to explore transition of care and follow‐up in the US pediatric‐onset MS (POMS) population. Methods Surveys were distributed to 10 sites in the US Network of Pediatric MS Centers (US NPMSC) about transition‐of‐care practices. A cohort of POMS/clinically isolated syndrome (CIS) at 12 US NPMSC sites was analyzed. The primary comparison was between < 18 and ≥ 18‐years of age. The primary outcome was 1‐ and 2‐year lapse in last follow‐up visit, measured from last recorded database visit to data lock date or, if ≥ 18 years of age, up to 1 year after a patient reached their site's typical transition age, if earlier. Secondary outcomes were baseline factors associated with follow‐up lapse. The model was adjusted for preidentified confounders. Results Compared with < 18 years, age ≥ 18 was associated with greater hazard of 1‐ and 2‐year follow‐up lapse. In POMS/CIS, the estimated hazard was 1.61 for 1‐year lapse (95% confidence interval [CI] 1.32–1.97, p < 0.001) and 1.40 for 2‐year lapse (95% CI 1.11–1.76, p = 0.004). In POMS‐only, the estimated hazard was 1.70 for 1‐year lapse (95% CI 1.33–2.18, p < 0.001) and 1.49 for 2‐year lapse (95% CI 1.11–1.99, p = 0.007). Platform injectable disease‐modifying therapy was associated with greater and intravenous with lesser hazard of lapse in follow‐up, while MS was associated with lower hazard than CIS. Conclusion Variable transition‐of‐care practices and barriers were reported by major US POMS centers. Before typical transition age, age ≥ 18 was associated with greater hazard of 1‐ and 2‐year follow‐up lapse than < 18. Developing standardized, targeted transition‐of‐care practices in POMS may be important.
Adenotonsillectomy is associated with increased risk and disease activity in pediatric-onset multiple sclerosis
Chang, Gina , Nasr, Z., Schoeps, Vinícius Andreoli , Virupakshaiah, Akash , Zamvil, Scott S, Moseley, Carson E. , Chong, Janet, Graves, Jennifer , Waltz, Michael , Tillema, Jan-Mendelt, Abrams, Aaron , Mar, Soe, Schreiner, Teri , Rose, John W. , Casper, T Charles, Nasr, Zahra , Graves, Jennifer , Rodriguez, Moses , Chitnis, Tanuja , Rensel, Mary R. , Abrams, Aaron , Krupp, Lauren , Schreiner, Teri , Rose, John W , Waubant, Emmanuelle L. , Virupakshaiah, Akash , Zamvil, Scott S. , Sabatino, Joseph J. , Chong, Janet, Rodriguez, Moses , Tillema, Jan‐Mendelt , Krupp, Lauren , Waldman, Amy , Mar, Soe , Casper, T. Charles
Multiple Sclerosis Journal | May 29, 2026 | Volume: No volume available | Issue: No issue available | Pages: No page available
Background: Epstein–Barr virus (EBV) is a key environmental risk factor for multiple sclerosis (MS), and tonsils and adenoids serve as a primary viral reservoir. This study investigates the potential role of adenotonsillectomy in pediatric-onset multiple sclerosis (POMS) risk and relapse rate. Objectives: POMS participants and controls were recruited from 16 pediatric MS clinics between 1 November 2011 and 1 July 2017. Clinical and demographic information, including history of adenotonsillectomy, EBV serostatus, and HLA-DRB1*15:01:01 status, were collected. Multivariable logistic regression assessed the association between adenotonsillectomy and MS risk. In addition, negative binomial regression offset by follow-up time was used to assess the relationship between adenotonsillectomy and relapse rate in POMS participants with available follow-up data. Results: The case-control analysis included 359 POMS participants and 560 pediatric controls. Individuals with a history of adenotonsillectomy had a 63% increased odds of MS (adjusted odds ratio (OR) = 1.63, 95% confidence interval (CI) = 1.01–2.64, p = 0.046). Among the 239 POMS participants with available follow-up data, adenotonsillectomy was associated with a twofold increase in annualized relapse rate (adjusted incidence rate ratio (IRR) = 2.00, 95% CI = 1.15–3.48, p = 0.013). Conclusions: Prior adenotonsillectomy was associated with increased risk of MS and greater relapse rate in pediatric patients, suggesting a potential interplay between EBV, immune regulation, and MS pathogenesis.