Swiss Pediatric Inflammatory Brain Disease Registry (Swiss-Ped-IBrainD)

Overview

The Swiss-Ped-IBrainD is a national patient registry that collects information on diagnosis, symptoms, treatment, and follow-up of pediatric patients with an inflammatory brain disease in Switzerland. It was first implemented in 2020 in the pediatric clinic of the university hospital in Bern. Further centers all over Switzerland were opened for recruitment in 2021; Aarau, Basel, Bellinzona, Chur, Geneva, Lausanne, Lucerne, St. Gallen, and Zurich. The center in Winterthur is expected to be open for recruitment by autumn 2021. The registry provides data for national and international monitoring and research. It supports research on inflammatory brain diseases in Switzerland and the exchange of knowledge between clinicians, researchers, and therapists. The registry aims to improve the treatment of children with inflammatory brain diseases and optimizing their health care and quality of life.

Description

Background

Pediatric onset MS and other inflammatory brain diseases (IBrainDs) are severe diseases affecting children and adolescents in a period of essential brain development. This possibly leads to a variety of focal neurological deficits as well as early cognitive impairment. In turn, the cognitive impairment may impact school performance and vocational achievements.

Timely diagnosis and treatment initiation as well as individually tailored management are important for a favorable disease course. However, the diagnosis of the different IBrainDs can be challenging, especially in young children, since their first acute inflammation is often accompanied by unspecific symptoms common to all IBrainDs. A systematic assessment of similarities and differences between clinical signs, symptoms, and diagnostic workup of different IBrainDs will enable faster and more reliable diagnosis.

Furthermore, neither epidemiological data nor information on health care management and disease outcome of pediatric IBrainD patients exist in Switzerland. Therefore, a national registry is being established, which will allow a deeper understanding of pediatric IBrainD epidemiology, clinical presentation, and management. Ultimately, the registry will improve the care of children suffering from an IBrainD in Switzerland.

The Swiss-Ped-IBrainD Registry (title: "Swiss Pediatric Inflammatory Brain Disease Cohort Study", project number: 2019-00377) has been approved by the ethics committees of Bern, the Ethikkommission Nordwest- und Zentralschweiz (EKNZ), the Ethikkommission Ostschweiz (EKOS), and the ethics committees of Zürich, Lausanne, Geneva, and Bellinzona.

Objectives

The registry pursues the following goals:

1. Gathering representative, population-based epidemiological data on pediatric IBrainD in Switzerland.
2. Monitoring treatment, clinical course, education, social aspects, and outcomes of pediatric IBrainD patients.
3. Providing a platform to facilitate research, national and international collaboration and exchange of knowledge between experts.

The registry thus addresses the increasing requests for medical trial participation and promotes the exchange with existing adult registries (e.g., Swiss MS Registry).

Inclusion/exclusion criteria:

All patients living and/or treated in Switzerland with an IBrainD specified in the following list with a disease onset before the age of 18.

• Optic neuritis
• Transverse myelitis
• Acute disseminated encephalomyelitis
• Multiple sclerosis
• Neuromyelitis optica spectrum disorders
• Anti-NMDA-R associated autoimmune encephalitis
• Anti-GAD65 associated autoimmune encephalitis
• Anti-AMPAR-1/2 associated autoimmune encephalitis
• Anti-Lgi-1 associated autoimmune encephalitis
• Anti-CASPR-2 associated autoimmune encephalitis
• Anti-GABAR-1/2 associated autoimmune encephalitis
• Onconeuronal antibody (Hu, Ri, Yo, Amphiphysin, CRMP-5, Ma-1, Ma-2, SOX-1) associated autoimmune encephalitis
• Hashimoto encephalopathy
• CNS vasculitis
• CNS sarcoidosis
• CNS Lupus
• Rasmussen's encephalitis

Excluded are patients with:

1. Neurological symptoms due to infectious diseases of the CNS
2. Genetic/metabolic causes of central demyelinating diseases
3. Neurological symptoms due to Guillain-Barré-Syndrome

Registration of Patients and Collection of Medical Data:

Pediatricians, pediatric neurologists, neurologists, specialists in rehabilitation, and primary care physicians at the participating centers are responsible to identify children with the listed IBrainDs during regular medical consultations. Upon identification, treating physicians inform patients and their parents orally and in writing about the Swiss-Ped-IBrainD. Patients (and their legal representatives if applicable) who want to participate must give their informed consent. Once a patient consents to participate, his/her medical data will be entered in the registry.

The diagnostic workup and treatment of patients continue as usual and are independent from participation; no examination will be carried out specifically for the Swiss-Ped-IBrainD.

Medical data is collected through the following sources:

• Medical records and reports
• Oral/written information from treating physician
• Oral/written information from patient/family
• Routine statistics and other medical registries
• Questionnaires for patients and families The data collection focuses on diagnostic, follow-up, and relapse variables.

Routine data and linkages:

Communities; Federal Statistical Office (e.g. the birth register, cause of death statistics, hospital statistics)

Current status:

From 2020-2021, the investigators have included 17 persons diagnosed with an IBrainD.

Funding

• Schweizerische Multiple Sklerose Gesellschaft
• PedNet Bern
• Roche Pharma (Switzerland) Ltd
• Novartis Pharma Schweiz AG
• SwissPedRegistry, University of Bern

Eligibility

Inclusion Criteria:

        All patients living and/or treated in Switzerland with an IBrainD specified in the
        following list with a disease onset before the age of 18.
          -  Written informed consent by patients (and/or legal representative(s), if applicable)
          -  Optic Neuritis
          -  Transverse Myelitis
          -  Acute disseminated encephalomyelitis
          -  Multiple Sclerosis
          -  Neuromyelitis Optica Spectrum Disorders
          -  Anti-NMDA-R Encephalitis
          -  Anti-GAD65 Associated Autoimmune Encephalitis
          -  Anti-AMPAR-1/2 Associated Autoimmune Encephalitis
          -  Anti-Lgi-1 Associated Autoimmune Encephalitis
          -  Anti-CASPR-2 Associated Autoimmune Encephalitis
          -  Anti-GABAR-1/2 Associated Autoimmune Encephalitis
          -  Onconeuronal Antibody (Hu, Ri, Yo, Amphiphysin, CRMP-5, Ma-1, Ma-2, SOX-1) Associated
             Autoimmune Encephalitis
          -  Hashimoto Encephalopathy
          -  CNS Vasculitis
          -  CNS Sarcoidosis
          -  CNS Lupus
          -  Rasmussen Encephalitis
        Exclusion Criteria:
          -  Neurological symptoms due to infectious diseases of the CNS
          -  Genetic/metabolic causes of central demyelinating diseases
          -  Neurological symptoms due to Guillain-Barré-Syndrome