{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T22:22:12Z","timestamp":1791843732067,"version":"4.3.4"},"reference-count":34,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T00:00:00Z","timestamp":1745798400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Mult Scler"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Pediatric-onset multiple sclerosis (POMS) constitutes ~5% of multiple sclerosis (MS) cases and presents distinct clinical and diagnostic challenges. Puberty, characterized by significant hormonal changes, may influence disease presentation, relapse rates, and long-term outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To investigate the impact of pubertal stages on clinical characteristics, relapse activity and disability progression in POMS using data from the Danish MS Registry (DMSR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      A nationwide cohort of 185 POMS patients were included and categorized by pre- (&lt;11 years), peri- (11\u201314 years), and post-pubertal (&gt;14 years) onset. Demographics, presenting symptoms, magnetic resonance imaging (MRI) findings, relapse rates, and Expanded Disability Status Scale (EDSS) scores were compared. Patients transitioning across the three pubertal stages (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 54) were analyzed longitudinally for relapse rate.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Pre-pubertal onset was associated with severe symptoms (cerebellar involvement,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.042), greater lesion burden, higher 10-year disability (EDSS median = 3.75,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.039), and lower relapse rates (annualized relapse rate (ARR) = 0.200). Male sex reduced relapse rates (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.013). Female-to-male ratio increased from 1:1 pre-puberty to ~2:1 after puberty. Patients with pre-pubertal onset transitioning to peri- or post-puberty showed increasing relapse rates, peaking during peri-puberty (ARR = 0.302).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Puberty significantly modulates disease course in POMS, emphasizing the need for early, sex-specific interventions, proactive monitoring, and further exploration of hormonal influences on disease progression and treatment response.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13524585251335476","type":"journal-article","created":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T06:57:38Z","timestamp":1745823458000},"page":"1061-1069","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Pediatric Onset Multiple Sclerosis (POMS): Exploring phenotypic characterization and pubertal influences in modulating the disease activity from the Danish MS Registry (DMSR)"],"prefix":"10.1177","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7950-0136","authenticated-orcid":false,"given":"Silvy","family":"Pilotto","sequence":"first","affiliation":[{"name":"Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1506-3827","authenticated-orcid":false,"given":"Luigi","family":"Pontieri","sequence":"additional","affiliation":[{"name":"The Danish Multiple Sclerosis Registry, Department of Neurology, Copenhagen University Hospital\u2014Rigshospitalet Glostrup, Glostrup, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helle Hvilsted","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Odense University Hospital, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter Vestergaard","family":"Rasmussen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina Bacher","family":"Svendsen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rikke","family":"Marie Jensen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Copenhagen University Hospital Danish Multiple Sclerosis Research Center, Glostrup, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morten","family":"Blinkenberg","sequence":"additional","affiliation":[{"name":"Department of Neurology, Copenhagen University Hospital Danish Multiple Sclerosis Research Center, Glostrup, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja","family":"Thormann","sequence":"additional","affiliation":[{"name":"Department of Neurology, Copenhagen University Hospital Danish Multiple Sclerosis Research Center, Glostrup, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3878-8820","authenticated-orcid":false,"given":"Eleonora","family":"Cocco","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Center, Binaghi Hospital, Azienda Sanitaria Locale Cagliari, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9396-8683","authenticated-orcid":false,"given":"Maura","family":"Pugliatti","sequence":"additional","affiliation":[{"name":"Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy"},{"name":"Interdepartmental Research 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