Abstract
Evaluation of: Banwell B, Bar-Or A, Arnold DL et al. Clinical, environmental, and genetic determinants of multiple sclerosis in children with acute demyelination: a prospective national cohort study. Lancet Neurol. 10(5), 436–445 (2011). This study represents a prospective Canadian cohort study investigating risk of multiple sclerosis (MS) development in children presenting with an acute demyelination event. Out of 302 children followed for a median of 3.14 years, 63 (21%) were diagnosed with MS during this period of time. HLA-DRB1*15 alleles, remote Epstein–Barr virus infection and reduced vitamin D levels were each independently associated with increased MS risk but did not show interacting effects. Based on MRI findings, age of onset and clinical presentation, the authors developed a decision tree, suggesting the highest risk for children with T2 lesions in baseline MRI that were >11.85 years of age at onset (60.6%). While this seems a helpful preliminary tool for clinicians, longer follow-up time as well as integration of additional genetic and environmental variables may allow an even more thorough risk estimation in future studies.
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