Tuesday, 20 December 2011

Cautious parents treating MS in Children

Waldman AT, Shumski MJ, Jerrehian M, Liu GT. Parent and Medical Professional Willingness to Enroll Children in a Hypothetical Pediatric Optic Neuritis Treatment Trial. Front Neurol. 2011;2:75.

The optic neuritis treatment trial (ONTT) and subsequent studies have had a tremendous impact on the treatment and prognosis of optic neuritis and multiple sclerosis in adults. The results of these studies have been extrapolated to children; however, pediatric data are sparse.

Using the method of prospective preference assessment, the willingness of parents and medical professionals to enroll children in a hypothetical Pediatric ONTT was assessed using a mock consent form and questionnaire. A three-arm trial was proposed: (1) intravenous corticosteroids, (2) high-dose oral corticosteroids, and (3) an oral placebo. The forms were completed by 198 parents and 49 physicians.

After reviewing the hypothetical scenario, trial design, risks and benefits, and alternatives to the study, 21% of parents would enroll their children in the trial whereas 98% of medical professionals would enroll their patients. With medical professional recommendation, 43% of parents would enroll their children.

The manner in which this hypothetical trial was presented to parents, specifically with respect to the recommendation of their child's health care team, influenced a parent's willingness to participate.

Whilst steroids are often used in Optic Neuritis in adults, people can still have vision problems even if they are given steroids. As such optic neuritis (inflammation of the optic nerve) has been targeted for a number of innovative trials for new MS drugs aimed at targeting problems in relapsing remitting and progressive MS.

Prof G and Friends will be doing one of these studies in adults in the New Year. It will be interesting to see how this recruits, however it is clear that we will need to properly inform if we are to recruit a reasonable rate. It is clear that parents are cautious when issues relate to their children (or are they?).

Prof G may comment on this

2 comments:

  1. If the trial didn't have the placebo grp it may have been different. I don't see why such a trial is needed. Children are given methylpred routinely for many less serious conditions and it works well for optic neuritis.

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  2. Maybe that is the reason, that the parent did their homework before declining but the neuuros could convince them in this hypothetical scenario

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