Home About Us Government Relations and Advocacy Media Contact Us Site Map Privacy Français  
 
Multiple Sclerosis Society of CanadaSociété canadienne de la sclérose en plaquesfinding a cure - enhancing quality of life

 


Research
    share +

Pediatric focus continues to shed new light on MS

View or print this bulletin in its original format.

You will need ADOBE ACROBAT READER to view this document listed above - it's FREE.

Medical Update Memo
April 7, 2010

Summary

Two pediatric studies report on diagnosis and prognosis for children with MS.

Details

1. A comparison of MRI criteria for diagnosing pediatric ADEM and MS

After a first inflammatory-demyelinating episode of the central nervous system (CNS), only some people will develop further neurological symptoms, being subsequently diagnosed with MS. However, predicting those people who will develop MS with the sets of criteria currently available is far from easy. Following a group of children who had experienced a first inflammatory-demyelinating episode of the CNS, the authors compared the ability of these sets of criteria to predict the development of MS. Neurology. 2010 Mar 24

Brain MRI is a useful tool for diagnosing inflammatory demyelinating disorders in children. However, it remains unclear which are the most reliable criteria for distinguishing multiple sclerosis (MS) from monophasic disorders such as acute disseminated encephalomyelitis (ADEM).

Investigators compared the 4 current sets of MRI criteria in a Dutch pediatric cohort and to determine which are the most useful in clinical practice for distinguishing ADEM from MS. 49 children who had had a demyelinating event and an MRI scan within 2 months of their first clinical attack were included. Twenty-one patients had ADEM and remained relapse-free after at least 2 years of follow-up. Twenty-eight patients had a definitive diagnosis of MS. Sensitivity and specificity of the following MRI criteria were assessed: Barkhof criteria, KIDMUS criteria, Callen MS-ADEM criteria, and Callen diagnostic MS criteria.

The Callen MS-ADEM criteria had the best combination of sensitivity (75%) and specificity (95%). The KIDMUS criteria had higher specificity (100%), but much lower sensitivity (11%). The Barkhof criteria had a sensitivity of 61% and a specificity of 91%. The Callen diagnostic MS criteria were the most sensitive (82%), but were only 52% specific for distinguishing a first attack of MS from ADEM.

Authors conclude that the results in this cohort demonstrate that the new Callen criteria for multiple sclerosis-acute disseminated encephalomyelitis (MS-ADEM) are the most useful for differentiating a first attack of MS from monophasic ADEM. Although the Callen diagnostic MS criteria are more sensitive, they lack the specificity necessary to differentiate MS from ADEM.

2. School performance in a cohort of children with CNS inflammatory demyelination

In this study the authors investigated the factors involved in poor school performance in a cohort of children who suffered from a first inflammatory-demyelinating episode of the central nervous system. They found that factors such as male gender, lower social status and a higher age at the moment of the first episode were associated with poorer school performance. They also found that children who had experienced optic neuritis or a brainstem syndrome as the first episode, especially if some degree of irreversible disability followed it, were associated with poorer school performance. Eur J Paediatr Neurol. 2010 Mar 5

Acute CNS inflammatory demyelination in childhood may induce permanent cognitive impairment. However, there has been no epidemiological assessment of prognostic factors for school performance in a cohort of children with such a disease.

The cohort consisted of 344 children from the French "KIDSEP" neuropediatric cohort with at least one clinically defined attack of CNS inflammatory demyelination occurring before the age of 16 years, and with at least two years of follow-up (inclusion from 1990 to 2003, follow-up until June 2007). Multivariate survival analysis (Cox model) was used to evaluate the prognostic value for grade retention between the start of elementary school ( approximately 6 years of age) and the end of high school ( approximately 17-18 years of age), of variables related to both the socioeconomic status of the parents and the characteristics of the disease at onset.

The cohort was monitored for a mean of 8.0+/-3.4 years. Grade retention after disease onset was recorded for 151 patients (43.9%). The risk of grade retention was significantly higher for boys, children from families with lower social status and poorer housing conditions, children over the age of 11 years at disease onset and children suffering optic neuritis or brainstem dysfunction at the first attack or irreversible disability, even if only moderate, following the first attack.

Authors conclude that the risk factors for poor school performance are related to low socioeconomic status and to factors predictive of a relapsing severe course of the disease, leading to the diagnosis of multiple sclerosis.

National Research and Programs

Offert en français.

Disclaimer
The Multiple Sclerosis Society of Canada is an independent, voluntary health agency and does not approve, endorse or recommend any specific product or therapy, but provides information to assist individuals in making their own decisions.

Back to top line