Brain Damage in Pediatric Multiple Sclerosis: Role of Social and Environmental Factors

Individuals who are born with multiple sclerosis (MS) and who are raised in underprivileged areas may exhibit greater levels of inflammation and brain tissue loss on imaging tests compared to those who are raised in more affluent areas().

Children rarely develop MS. Approximately 5% of MS patients receive a diagnosis before turning 18.

‘Young people with #Multiplsclerosis from underprivileged backgrounds show greater #brain_inflammation & tissue loss on scans. Social factors accounted for significant differences in brain lesions and black hole volumes in MS patients. #medindia’

People who self-identified as Black or Latino, those from families with parents with lower educational attainment, and those with public health insurance-a sign of poor household income-all had inferior brain imaging results in addition to neighborhood location.

"Our results indicate that childhood social disadvantage may have long-term impacts on the severity of multiple sclerosis," stated Kimberly A. O'Neill, MD, of New York University Grossman School of Medicine.

Childhood is a critical period for exposure to environmental factors, such as pollution, low sunlight exposure, and passive smoke, linked to an increased susceptibility to MS. More research is required to determine which factors in underprivileged communities raise young people's chance of developing severe MS.

The study involved 138 people with an average age of 20 who were diagnosed with MS before age 18, known as pediatric-onset MS. They had been diagnosed with MS for an average of four years.

All had brain scans to measure areas of brain inflammation and injury due to MS and brain volume loss. Researchers collected information on social factors that may impact a person's health, including self-reported race and ethnicity, type of health insurance, parents' education level, and the degree of neighborhood advantage or disadvantage.

Social factors associated with disadvantage correlated with greater volume of inflammatory lesions in the white matter of the brain and also with greater black hole volume, which is a sign of irreversible loss of brain tissue.

Together, the identified social factors accounted for 26% of the difference in white matter lesion volume and 23% of the difference in black hole volume among participants.

Once all factors were taken into account, having public health insurance was the strongest predictor of having greater amounts of inflammation and tissue loss.

People with public health insurance had an average white matter lesion volume that was larger than people with private insurance. They also had average black hole volumes larger than those with private insurance.

The researchers found that the differences were not explained by how soon a neurologist saw children, how quickly they were started on medication for MS or how effective their medications were at slowing their disease progress.

"This suggests that access to health care does not explain the more severe disease burden shown in the brain scans of people in disadvantaged groups in our study," O'Neill said.

"While these are associations and not causes, many of these groups have historically been underrepresented in MS research and our work here is just beginning."

A limitation of the study is that researchers used the addresses of the children at the time of their diagnosis but did not have information on any prior addresses. Additionally, only a few types of social factors were studied.

Reference:

1. Association of Social Determinants of Health With Brain MRI Outcomes in Individuals With Pediatric Onset Multiple Sclerosis - (https:www.neurology.org/doi/10.1212/WNL.0000000000210140)

Source: Eurekalert