{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T08:29:19Z","timestamp":1786350559477,"version":"build-2736575974"},"reference-count":78,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"PROMISING study\u201d"},{"name":"Universit\u00e0 degli Studi di Bari Aldo Moro"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Neurol"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Paediatric-onset multiple sclerosis (POMS) accounts for 3\u201310% of multiple sclerosis (MS) cases and differs from adult-onset disease in course, treatment response and long-term outcomes. Risk stratification is essential, yet the literature frequently conflates three distinct questions: which children develop MS (susceptibility), which convert from a first demyelinating event (conversion) and which, once diagnosed, will accrue disability (prognosis).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to provide a narrative overview of candidate prognostic factors in POMS, separated from susceptibility and conversion factors and organised by the outcome each predicts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed and Google Scholar were searched (2002\u20132025, with hand searching of pivotal 2026 cohorts) using a predefined string and full eligibility criteria. Factors were classified along three axes of inference and graded into four evidence tiers (replicated; preliminary; susceptibility rather than prognosis; inconsistent). No formal risk-of-bias assessment was undertaken, consistent with the narrative design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The most reproducible post-diagnosis predictors were early inflammatory activity (relapse number and inter-attack interval in the first two years, annualised relapse rate, early EDSS change), lesion topography (brainstem, spinal cord), T2 lesion accrual, serum neurofilament light chain and treatment-related variables (delayed disease-modifying therapy, early high-efficacy treatment). Advanced MRI metrics, serum glial fibrillary acidic protein and other fluid biomarkers remain preliminary; baseline EDSS was inconsistent. Most dietary, environmental and perinatal exposures relate to susceptibility, not course.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Current evidence supports candidate predictors, not a validated instrument, and inference is further complicated by confounding by indication. A multidimensional, externally validated POMS-specific prognostic score remains to be developed\u2014the aim of the ongoing PROMISING study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-026-14029-z","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T14:25:58Z","timestamp":1785335158000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic factors in paediatric-onset multiple sclerosis: a narrative review"],"prefix":"10.1007","volume":"273","author":[{"given":"Mariaclara","family":"Achille","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimiliano","family":"Copetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso","family":"Guerra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caterina","family":"Ferri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Iaffaldano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"D\u2019Alfonso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maura","family":"Pugliatti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Palumbi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4381-4613","authenticated-orcid":false,"given":"Marta","family":"Simone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"issue":"3","key":"14029_CR1","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1097\/WCO.0000000000001366","volume":"38","author":"S Tenembaum","year":"2025","unstructured":"Tenembaum S, Hartung HP (2025) Multiple sclerosis: advances and challenges in diagnosis. 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