Researchers conduct a retrospective study to determine whether children with MS can be diagnosed after an initial event and MRI.
SAVANNAH, GA—Applying the 2010 Revised McDonald Diagnostic Criteria for Multiple Sclerosis (MS) could have led to an earlier diagnosis among some pediatric demyelinating patients, according to research presented at the 40th National Meeting of the Child Neurology Society.
“Revised 2010 MS diagnostic criteria now allow a single brain MRI with more than one T2 lesion in at least two regions and one enhancing lesion to fulfill dissemination in time and space,” noted Thitiwan Simasathien, MD, Child Neurology Fellow, and Jayne M. Ness, MD, PhD, Associate Professor, both at the University of Alabama in Birmingham. “However, this streamlined diagnosis of MS had not been validated in pediatric demyelinating patients.”
Evaluating the 2010 MS Diagnostic Criteria
The investigators conducted a retrospective chart review evaluating the utility of the 2010 MS diagnostic criteria in a cohort of 42 pediatric patients with MS. All participants (70% female, 40% African American) were younger than 18 and presented with clinically isolated syndrome (CIS) from 1998 to 2008, with a mean onset age of 13.1. Of the patients, none were documented with encephalopathy, six presented with optic neuritis (five unilateral, one bilateral), and 36 presented with pyramidal or brainstem symptoms.
The researchers determined whether the first MRI conducted on these patients fulfilled 2010 MS diagnostic criteria, finding that 40% of the cohort (17/42) showed dissemination in time and space on their initial MRI. Drs. Simasathien and Ness noted no differences in age, race, or sex between patients who met the 2010 diagnostic criteria and those who did not.
If the 2010 criteria had been applied to the participants at the time of their initial CIS presentation, some patients could have received an earlier diagnosis of MS and potentially could have begun disease-modifying therapy sooner, the investigators concluded. Although the findings of the retrospective study show promise, “Further study is necessary to assess the validity of these criteria in pediatric demyelinating patients,” the researchers stated.
Dr. Ness told Neurology Reviews, “It will be critical to assess whether the streamlined 2010 McDonald criteria have appropriate specificity to ensure that children with self-limited demyelinating syndromes—such as acute disseminated encephalomyelitis or conditions requiring different treatment approaches, such as neuromyelitis optica—are not incorrectly diagnosed with MS.”