Brain Lesion Load and Anatomic Distribution in Patients With Juvenile Clinically Isolated Syndrome Predicts Rapidly Advanced to Multiple Sclerosis

Abstract

The aim was to assess brain lesion load and anatomical distribution in patients with juvenile clinically isolated syndrome and define magnetic resonance imaging (MRI) variables associated with rapidly advancing to multiple sclerosis. Patients were followed for one year after disease onset. Patients who experienced a second relapse were defined as those who rapidly advanced to multiple sclerosis. In all, 46 juvenile patients with a clinical presentation suggestive of multiple sclerosis were evaluated; 21 with gadolinium-enhancing lesions on initial brain MRI were excluded as they had already fulfilled the diagnosis criteria for multiple sclerosis. A total of 25 patients, 10 males and 15 females (mean ± SE age at onset 15.6 ± 0.6 years), met the definition of clinically isolated syndrome. The presence of a corpus callosum lesion at onset significantly differentiated between sustained clinically isolated syndrome and patients who rapidly advanced to multiple sclerosis.

MRI in predicting conversion to multiple sclerosis within 1 year

“…Some baseline MRI characteristics may also serve as predictors of the above, including the number of lesions, the distribution, and activity of the lesions (like those determined by the Barkhof criteria: the occurrence of a gadolinium-enhancing lesion; and the presence of a juxtacortical, infratentorial, or periventricular lesion (Barkhof et al, 1997;Tintore et al, 2006)), baseline lesion load (the proportion of brain voxels occupied by lesions), lesion distribution, and the location of the lesions within major white matter tracts (Tintore et al, 2006). A study by Menascu, Legrada, Miron, and Achiron (2017) recently checked conversion of CIS to MS in the first year in pediatric patients and found that high lesion load and location in the parietal lobe are predictors for conversion in the first year.…”

Attention Deficit/Hyperactivity Disorder in Children with Multiple Sclerosis

“…In POMS, there is also an overactivation of the immune system during the adolescent period, as can be seen by a higher relapse rate of elevated levels of inflam matory markers in individuals with ADHD. This may indi cate a shared immune dysregulation happening similarly in both processes (Menascu et al, 2018(Menascu et al, , 2021. As the main pathology in MS is the immune system's attack on myelin, leading to impaired neural transmission and disruption of neural pathways at a period when brain development of attention and other cognitive processing takes part (Wekerle & Lassmann, 2005).…”