{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T22:22:08Z","timestamp":1791843728031,"version":"4.3.4"},"reference-count":21,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2013,12,16]],"date-time":"2013-12-16T00:00:00Z","timestamp":1387152000000},"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":["Euro J of Neurology"],"published-print":{"date-parts":[[2014,3]]},"abstract":"Background and purpose<\/jats:title>Multiple sclerosis (MS) onset before puberty is extremely rare and establishment of diagnosis is often difficult due to atypical presentation. The study aims to identify the typical presentation of MS in this age group.<\/jats:p><\/jats:sec>Methods<\/jats:title>Pediatric MS patients were identified from the database of the C<\/jats:styled-content>enter for M<\/jats:styled-content>ultiple S<\/jats:styled-content>clerosis in C<\/jats:styled-content>hildhood and A<\/jats:styled-content>dolescence at the U<\/jats:styled-content>niversity M<\/jats:styled-content>edical C<\/jats:styled-content>enter G<\/jats:styled-content>\u00f6ttingen, G<\/jats:styled-content>ermany. Inclusion criteria were a relapsing\u2212remitting initial disease course and minimum disease duration of 4\u00a0years.<\/jats:p><\/jats:sec>Results<\/jats:title>Forty\u2010seven pre\u2010pubertal (<11\u00a0years) and 41 post\u2010pubertal (14\u201316\u00a0years) MS<\/jats:styled-content> patients were compared. Before puberty an even gender ratio was found. The pre\u2010pubertal patients were more likely to have a polysymptomatic severe first attack with motor and brainstem involvement, sphincter dysfunction, cognitive disturbances and milder residual neurological sequelae after the first episode whilst the post\u2010pubertal patients predominantly presented with optic neuritis and sensory symptoms. The initial symptom pattern prevailed over the first 2\u00a0years of disease. Presentation of pre\u2010pubertal boys and girls did not differ significantly.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>To facilitate early diagnosis it is important to recognize that pre\u2010pubertal MS presents with a specific pattern of symptoms that is maintained over the first two disease years.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.12327","type":"journal-article","created":{"date-parts":[[2013,12,16]],"date-time":"2013-12-16T08:16:49Z","timestamp":1387181809000},"page":"441-446","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":95,"title":["Clinical presentation of pediatric multiple sclerosis before puberty"],"prefix":"10.1111","volume":"21","author":[{"given":"B.","family":"Huppke","sequence":"first","affiliation":[{"name":"Department of Pediatrics and Pediatric Neurology University Medical Center Georg August University G\u00f6ttingen G\u00f6ttingen 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