Cognitive Ability in Pediatric-Onset Multiple Sclerosis: A Case Series

Pediatr Neurol. 2026 Feb 25;178:157-163. doi: 10.1016/j.pediatrneurol.2026.02.015. Online ahead of print.

ABSTRACT

BACKGROUND: Pediatric-onset multiple sclerosis (POMS) emerges during a crucial stage of neurodevelopment, conferring special vulnerability to neurological damage and cognitive decline. This underscores the importance of addressing cognitive domain and identifying its prognostic factors and treatment.

METHODS: Retrospective descriptive study of a cohort of children with POMS in a tertiary pediatric hospital from 2010 to 2023. Cognitive and clinical characteristics during neuropsychological assessments were analyzed.

RESULTS: Twelve patients were included (average disease onset 11.5 years). Cognitive assessments showed an overall improvement, being close to statistical significance in visual perceptual organization and speed/accuracy of the dominant hand. Earlier disease onset and younger age at the time of assessment were associated with worse nonverbal skills. A higher number of relapses, Expanded Disability Status Scale score, increased lesion burden, and basal ganglia involvement were significantly correlated with worse cognitive performance in multiple domains. Fingolimod therapy and longer treatment duration were related to better cognitive outcomes.

CONCLUSIONS: Children with POMS presenting at a younger age are at increased risk of cognitive impairment, especially during the early stages of the disease. Some clinical and radiological factors can predict worse intellectual performance, while high-efficacy disease-modifying treatment like Fingolimod and its precocious initiation is associated with better cognitive prognosis.

PMID:41844096 | DOI:10.1016/j.pediatrneurol.2026.02.015