Impaired Cognition without Behavioral Problems in Pediatric Clinically Isolated Syndrome (CIS) (P02.113)

OBJECTIVE: To characterize cognitive and behavioral functioning in children younger than 18 years of age with clinically isolated syndrome (CIS). BACKGROUND: Cognitive impairment is estimated to occur in one third of children with MS, but its frequency at the time of the first clinical event i.e. in CIS, is unknown. As cognitive impairment occurs in adults at this disease stage, we hypothesized that cognitive impairments would also be identified in pediatric CIS. DESIGN/METHODS: We evaluated 44 children with pediatric CIS, enrolled from six pediatric MS centers across the USA. Participants completed a cognitive test battery and participants and parents completed the Behavior Assessment System for Children, Second Edition (BASC-2) as a measure of psychological distress. We defined cognitive impairment as poor test performance (one standard deviation (SD) or more below published normative values) on ≥ 1/3 of completed test measures. RESULTS: At the time of testing, participants had a mean age of 14.8± 2.6 years , symptom duration of 0.8±1.7 years, and a median Expanded Disability Status Scale (EDSS) of 1.3 (0 to 6.5). A total of 8 (18%) with pediatric CIS met criteria for cognitive impairment. Poor test performance was most frequently found in visuomotor integration (57%) and speeded information processing (34%). Elevated symptoms of psychological distress were most commonly reported on parent ratings of depression (n=5, 11%), anxiety (n=4, 9%) and somatization (n=4, 9%). The number of behavioral scales (parent and self) rated in the clinically significant range was not associated with number test performances below 1 SD of published norms (r=.02, p>.94), EDSS (r=.20, p>.43), or presence of overall cognitive impairment. Participants in the sample who were classified with cognitive impairment had higher EDSS scores (p CONCLUSIONS: Cognitive impairment is detectable in pediatric CIS, and is associated with EDSS but not patient- or parent-reported psychological distress. Supported by: National Multiple Sclerosis Society. Disclosure: Dr. Krupp has received personal compensation for activities with Teva Neuroscience, Biogen Idec, EMD Serono, MEDA Corp, Acorda Therapeutics, Betaseron/Bayer Healthcare, Gerson Lehrman Group, Guidepoint Global, Adler, Cohen, Harvey and Wakeman. Dr. Krupp has received royalty payments from Genzyme, Zymogenetics, Ortho-McNeil, and ER Squibb & Sons. Dr. Krupp has received research support from Genentech, Biogen Idec, Teva Neuroscience, Celgene Corporation, Garnett McKeen Laboratory Incorporated, the National Institutes of Health, Slomo and Cindy Silvian Foundation, MS Foundation and the Lourie Foundation. Dr. Charvet has nothing to disclose. Dr. Serafin has nothing to disclose. Dr. Julian has received personal compensation for activities with Genentech, Inc. as an employee. Dr. Ackerson has nothing to disclose. Dr. Benedict has received personal compensation for activities with Actelion, Biogen Idec, Bayer, Novartis, MedImmune, EMD Serono and Teva Neuroscience. Dr. Benedict has received royalty payments from Psychological Assessment Resources. Dr. Benedict has received research support from Acorda Therapeutics and Biogen Idec. Dr. Braaten has nothing to disclose. Dr. Brown has nothing to disclose. Dr. O9Donnell has nothing to disclose. Dr. Parrish has nothing to disclose. Dr. Preston has nothing to disclose. Dr. Zaccariello has nothing to disclose. Dr. Belman has nothing to disclose. Dr. Chitnis has received personal compensation for activities with Biogen Idec, Novartis, Sanofi-Aventis Pharmaceuticals, EMD-Serono, and Teva Neuroscience. Dr. Chitnis has received research support from Merck Serono. Dr. Gorman has receievd personal compensation for activities with Actelion, Shire HGT, Orphazyme, Stem cells, Inc, and Amicus. Dr. Gorman has received research support from NIH and Actelion. Dr. Kaufman has nothing to disclose. Dr. Ness has nothing to disclose. Dr. Patterson has nothing to disclose. Dr. Rodriguez has nothing to disclose. Dr. Waubant has received personal compensation for activities with Actelion, Roche Diagnostics Corporation, Sanofi-Aventis and Teva Neuroscience as a consultant, advisory board member and/or speaker. Dr. Waubant has received research support from Roche Diagnostics Corporation, Biogen Idec and Sanofi-Aventis. Dr. Weinstock-Guttman has received personal compensation for activities with Acorda Therapeutics, Biogen Idec, Serono Inc., Novartis, Pfizer, Inc., Teva Neuroscience and Genentech, Inc. as a speaker and/or participant on an advisory board. Dr. Weinstock-Guttman has received research support from the National Multiple Sclerosis Society, the National Institutes of Health, ITN, Teva Neuroscience, Biogen Idec, Serono Inc., Aspreva-Roche, Acorda Therapeutics & Cognition, Shire Pharmaceuticals Group and Novartis. Dr. Yeh has nothing to disclose.