Highlights
- •Incidence and prevalence were combined across 4 continents and 15 countries.
- •Incidence estimates were similar across regions; prevalence was more variable.
- •Prevalence of pediatric MS was found to be lowest in the Asia region.
- •Lack of estimates from other large regions (e.g. Africa, Russia, and Australia).
Abstract
Background
Multiple sclerosis (MS) is a debilitating immune disease leading to demyelination,
neurodegeneration, and chronic inflammation of the central nervous system. Pediatric
MS is a rare form of the disease and effects approximately 2–10% of individuals with
MS. Diagnostic criteria and therapies are continuously evolving, thus it is imperative
to further understand the epidemiology and subsequently global and regional disease
burden of pediatric MS. Our objective was to conduct a systematic literature review
and meta-analysis to assess the incidence and prevalence of pediatric MS globally.
Subgroup analyses were also conducted by region and diagnostic criteria used to ascertain
cases.
Methods
A systematic literature review was conducted using searches run in EMBASE and MEDLINE.
A hand search was also conducted, and the bibliographies of any relevant articles
were reviewed for any studies potentially not captured by the databases. A random
effects model was used to combine epidemiological estimates across studies. Subgroup
analyses by region and diagnostic criteria were performed in instances when three
or more studies were available for analyses.
Results
A total of 2,965 publications were identified, of which 187 were eligible for full-text
screening. A total of 21 full-text articles met the eligibility criteria and were
included for data extraction, with 18 studies included for meta-analysis. Regional
epidemiologic estimates were obtained for North America, Europe, Middle East, and
Asia. Country specific data was available for Canada, United States, Germany, Iceland,
Netherlands, Sardinia, Slovenia, UAE/Abu Dhabi, Iran, Israel, Jordan, Kuwait, Tunisia,
Taiwan, and Japan. Thirteen studies representing 12 countries reported incidence of
pediatric MS. Overall incidence ranged from 0.05 to 2.85 and pooled global incidence
was calculated to be 0.87 (95% CI: 0.35–1.40) per 100,000 individuals annually. Ten
studies representing 10 countries reported on the prevalence of pediatric MS. Overall
prevalence ranged from 0.69 to 26.92 per 100,000 individuals and pooled global prevalence
was calculated to be 8.11 (95% CI: 2.28–13.93) per 100,000 people.
Conclusion
To our knowledge, this is the first meta-analysis conducted to provide pooled estimates
of incidence and prevalence estimates of pediatric MS globally. In general, incidence
estimates were similar across regions; however, prevalence was found to be more variable.
Noticeable gaps in evidence include a lack of pediatric MS estimates from other large
regions of the world such as Africa, South America, Russia, and Australia. Moreover,
there is a need for more population-based studies using the most up to date diagnostic
criteria.
Keywords
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Article info
Publication history
Published online: June 04, 2020
Accepted:
June 1,
2020
Received in revised form:
May 8,
2020
Received:
March 24,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
