{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T03:13:51Z","timestamp":1792466031313,"version":"4.5.0"},"reference-count":56,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2021,2,27]],"date-time":"2021-02-27T00:00:00Z","timestamp":1614384000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Neurology"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The purpose of this study was to assess early predictors of 9\u2010year disability in pediatric patients with multiple sclerosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Clinical and magnetic resonance imaging (MRI) assessments of 123 pediatric patients with multiple sclerosis were obtained at disease onset and after 1 and 2\u2009years. A 9\u2010year clinical follow\u2010up was also performed. Cox proportional hazard and multivariable regression models were used to assess independent predictors of time to first relapse and 9\u2010year outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Time to first relapse was predicted by optic nerve lesions (hazard ratio [HR] = 2.10, <jats:italic>p<\/jats:italic> =\u20090.02) and high\u2010efficacy treatment exposure (HR = 0.31, <jats:italic>p<\/jats:italic> =\u20090.005). Predictors of annualized relapse rate were: at baseline, presence of cerebellar (\u03b2 = \u22120.15, <jats:italic>p<\/jats:italic> &lt;\u20090.001), cervical cord lesions (\u03b2 = 0.16, <jats:italic>p<\/jats:italic> =\u20090.003), and high\u2010efficacy treatment exposure (\u03b2 = \u22120.14, <jats:italic>p<\/jats:italic> =\u20090.01); considering also 1\u2010year variables, number of relapses (\u03b2 = 0.14, <jats:italic>p<\/jats:italic> =\u20090.002), and the previous baseline predictors; considering 2\u2010year variables, time to first relapse (2\u2010year: \u03b2 = \u22120.12, <jats:italic>p<\/jats:italic> =\u20090.01) entered, whereas high\u2010efficacy treatment exposure exited the model. Predictors of 9\u2010year disability worsening were: at baseline, presence of optic nerve lesions (odds ratio [OR] = 6.45, <jats:italic>p<\/jats:italic> =\u20090.01); considering 1\u2010year and 2\u2010year variables, Expanded Disability Status Scale (EDSS) changes (1\u2010year: OR = 26.05, <jats:italic>p<\/jats:italic> &lt;\u20090.001; 2\u2010year: OR = 16.38, <jats:italic>p<\/jats:italic> =\u20090.02), and \u2265\u20092 new T2\u2010lesions in 2\u2009years (2\u2010year: OR = 4.91, <jats:italic>p<\/jats:italic> =\u20090.02). Predictors of higher 9\u2010year EDSS score were: at baseline, EDSS score (\u03b2 = 0.58, <jats:italic>p<\/jats:italic> &lt;\u20090.001), presence of brainstem lesions (\u03b2 = 0.31, <jats:italic>p<\/jats:italic> =\u20090.04), and number of cervical cord lesions (\u03b2 = 0.22, <jats:italic>p<\/jats:italic> =\u20090.05); considering 1\u2010year and 2\u2010year variables, EDSS changes (1\u2010year: \u03b2 = 0.79, <jats:italic>p<\/jats:italic> &lt;\u20090.001; 2\u2010year: \u03b2 = 0.55, <jats:italic>p<\/jats:italic> &lt;\u20090.001), and \u2265\u20092 new T2\u2010lesions (1\u2010year: \u03b2 = 0.28, <jats:italic>p<\/jats:italic> =\u20090.03; 2\u2010year: \u03b2 = 0.35, <jats:italic>p<\/jats:italic> =\u20090.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>A complete baseline MRI assessment and an accurate clinical and MRI monitoring during the first 2\u2009years of disease contribute to predict 9\u2010year prognosis in pediatric patients with multiple sclerosis. ANN NEUROL 2021;89:1011\u20131022<\/jats:p><\/jats:sec>","DOI":"10.1002\/ana.26052","type":"journal-article","created":{"date-parts":[[2021,2,18]],"date-time":"2021-02-18T07:22:35Z","timestamp":1613632955000},"page":"1011-1022","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Early Predictors of 9\u2010Year Disability in Pediatric Multiple Sclerosis"],"prefix":"10.1002","volume":"89","author":[{"given":"Ermelinda","family":"De Meo","sequence":"first","affiliation":[{"name":"Neuroimaging Research Unit, Division of Neuroscience IRCCS San Raffaele Scientific Institute  Milan Italy"},{"name":"Vita\u2010Salute San Raffaele University  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaello","family":"Bonacchi","sequence":"additional","affiliation":[{"name":"Neuroimaging Research Unit, Division of Neuroscience IRCCS San Raffaele Scientific Institute  Milan Italy"},{"name":"Neurology Unit 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Pia","family":"Amato","sequence":"additional","affiliation":[{"name":"Department NEUROFARBA, Section of Neurosciences University of Florence  Florence Italy"},{"name":"IRCCS Fondazione Don Carlo Gnocchi  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vittorio","family":"Martinelli","sequence":"additional","affiliation":[{"name":"Neurology Unit IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2358-4320","authenticated-orcid":false,"given":"Maria Assunta","family":"Rocca","sequence":"additional","affiliation":[{"name":"Neuroimaging Research Unit, Division of Neuroscience IRCCS San Raffaele Scientific Institute  Milan Italy"},{"name":"Vita\u2010Salute San Raffaele University  Milan Italy"},{"name":"Neurology Unit IRCCS San Raffaele Scientific Institute  Milan 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