Abstract
Objective: To determine the utility of revised 2010 MS diagnostic criteria in a pediatric MS cohort. Background In adults, early diagnosis of MS and implementation of disease modifying therapy (DMT) has been shown to reduce long term disability. McDonald criteria, initially published in 2001 and revised in 2005, enabled diagnosis of MS after an initial demyelinating event (IDE) by allowing accumulation of T2 and gadolinium enhancing lesions on serial cranial or spinal cord MRIs to serve as a surrogate for dissemination in time and space. Revised 2010 MS diagnostic criteria now allows a single brain MRI with >1 T2 lesion in at least 2 regions and 1 asymptomatic enhancing lesion to fulfill dissemination in time and space. However, this streamlined diagnosis of MS has not been validated in pediatric demyelinating patients. Design/Methods: Retrospective chart review of pediatric MS patients from 1998-2011 with application of 2010 MS diagnostic criteria. Results: The cohort consisted of 77 pediatric MS patients with all their neuroimaging available for review (68% female, 43% black, 57% white). Mean age of demyelinating symptom onset was 13.4 ± 0.4 years. Optic neuritis was an initial symptom in 10 patients (9 unilateral, 1 bilateral). Four patients presented with acute disseminated encephalomyelitis (ADEM) with encephalopathy and another four were initially followed for radiologically isolated syndrome (RIS). The rest exhibited pyramidal or brainstem syndromes. Of the 67 patients whose initial MRIs were performed with gadolinium, 42% (n=28) fulfilled 2010 McDonald diagnostic criteria, including 1 ADEM and 1 RIS. There was no difference with respect to age, race or sex between patients fulfilling 2010 criteria and those who did not. Conclusions: 2010 criteria may enable earlier diagnosis of MS in adolescents Further study is necessary to assess validity of these criteria in younger pediatric demyelinating patients. Supported by: National Multiple Sclerosis Society. Disclosure: Dr. Ness has received research support from EMD Serono. Dr. Simasathien has nothing to disclose.
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