Multiple sclerosis (MS) is an inflammatory demyelinating and neurodegenerative disease. Although cognitive impairment has been well established in adult patients with MS, its occurrence in patients with pediatric-onset MS has recently been reported. In this review, I discuss the main features of cognitive impairment in pediatric MS as determined by long-term follow-up studies, neuropsychiatric test batteries, and the results of neuroradiological imaging studies that investigated the pathogenesis of pediatric MS. The most commonly affected cognitive domains in adults are attention, processing speed, and visuomotor skills; language and intelligence are also affected in pediatric MS. A young age at disease onset is the strongest risk factor for these impairments, which may be due to the effect of inflammatory demyelination and neurodegeneration on the developing central nervous system and neural networks in children. Cognitive impairment has long-term effects on patients’ academic life and the quality of their social life. Therefore, all patients with pediatric MS should be screened and monitored for cognitive impairment. This review also highlights the need for neuropsychological test batteries that assess different cognitive domains in children and adolescents with multiple sclerosis and for cognitive rehabilitation programs to improve the quality of their academic and social life.

Objective. The aim of our study was to investigate the frequency and pattern of cognitive impairment in patients with clinically isolated syndromes and definite diagnosis of multiple sclerosis within the last 2 years.Methods. We assessed the cognitive status of 46 patients aged 18–49 years with clinically isolated syndromes or definite diagnosis of multiple sclerosis who have onset of their symptoms within the last 2 years. Patients were matched with 40 healthy participants for age, sex, and educational level. Neuropsychological assessment was performed by stroop test, paced auditory serial addition test (PASAT), controlled oral word association test (COWAT), clock drawing test, trail making test (TMT), faces symbol test (FST). Hamilton Depression Scale and Modified Fatigue Impact Scale were used to quantify the severity of any depression and fatigue the subjects might suffer.Results. 19.6% of early MS/CIS group failed at 4 and more tests and had significant cognitive impairment focused on attention, executive functions, memory, and learning. No significant relationship was found between cognitive impairment and disability and fatigue scores.Discussion. Cognitive impairment can be present from the earliest stage of multiple sclerosis. It should be considered among the main manifestations of MS even in the earliest stages of the disease.

Although anti-CD20 treatments are effective in inflammatory neurological diseases, they have some risks, especially infections. Determining the predictor factors of infection helps risk management in patients receiving anti-CD20 treatments. The effect of ocrelizumab (OCR) and rituximab (RTX) associated hypogammaglobulinemia (HGG) and lymphopenia on infection risk is controversial. The aim of this study to evaluate relationship between HGG and lymphocytopenia and infection risk and infection-related mortality in patients under RTX and OCR treatments and also compare these parameters between two agents. In our findings no relationship was found between HGG and infection risk in patients receiving OCR and RTX. In the RTX group, a significant relationship was detected between lymphocytopenia and severe infection. And, all three patients with infection-related mortality under rituximab treatment had HGG. No infection-related mortality was happened in OCR treatment. While lymphocytopenia and HGG were not detected as significant risk factors for infection, older age, female gender and > 4 EDSS score were determined as risk factors for infection in patients receiving OCR treatment. Identifying factors predicting infection risk may provide better risk management in patients receiving anti-CD20 therapy.