Improved performance of the 2017 McDonald criteria for diagnosis of multiple sclerosis in children in a real-life cohort

Abstract

Objective: To compare the performance of the 2017 McDonald criteria with that of the 2010 criteria for the diagnosis of multiple sclerosis (MS) in children in the clinical setting. Methods: In this retrospective, multi-centre study, we identified children who presented with symptoms suggestive of a clinically isolated syndrome (CIS) and were followed up for at least 2 years or until their second attack. Results: Of 156 children with CIS followed up for a median of 4.17 years, 94 (60.3%) were diagnosed with MS. In all, 83 (88.3%) of these fulfilled the 2010 dissemination in space (DIS) criteria at onset. Three additional children fulfilled the 2017 DIS criteria because of the inclusion of symptomatic lesions. Of the 59 children with MS who underwent post-gadolinium magnetic resonance imaging (MRI), 44 (74.6%) fulfilled the 2010 dissemination in time (DIT) criteria at baseline. When the presence of oligoclonal bands (OCBs) was used to substitute DIT, an additional 35 children (79/94, 84.0%) were diagnosed with MS according to the 2017 criteria. The 2017 criteria had higher accuracy (87.2% vs 66.7%), higher sensitivity (84.0% vs 46.8%), but reduced specificity (91.9% vs 96.8%) when compared to the 2010 criteria. Conclusion: The improved performance of the 2017 criteria when compared to the 2010 criteria was predominantly due to the inclusion of intrathecal OCBs.

Paediatric multiple sclerosis and antibody-associated demyelination: clinical, imaging, and biological considerations for diagnosis and care

“…With these caveats, the 2017 McDonald MS criteria perform well in the pediatric population, including in children younger than 12 years with non-ADEM presentation, with comparable sensitivity to adult-onset diagnostics, and high specificity 3,33,34 . The 2017 criteria re-emphasize the contribution of CSF oligoclonal bands (OCBs) to MS diagnosis, with has been affirmed in pediatric cohorts 3 .…”

What does first-line therapy mean for paediatric multiple sclerosis in the current era?

“…Paediatric MS has an incidence ranging between 0.13 and 0.66 per 100,000 children per year. 3 The median age at presentation is 13.7 years, 4 and although isolated reports of MS presenting in young prepubertal children, the majority of paediatric patients are teenagers. POMS is associated with a high relapse rate, 5 rapid MRI lesion accrual early in the disease course 6 risk for adverse cognitive outcomes 7 and potentially with the risk for physical disability in the long term.…”

Current Advances in Pediatric Onset Multiple Sclerosis

“…The criteria have only a 55% positive predictive value in children under 11, and should not be applied to those with an ADEM presentation [38]. More recently, the revised 2017 McDonald criteria were compared to the prior 2010 criteria in a pediatric cohort and demonstrated improvement in accuracy (87.2% vs 66.7%) and sensitivity (84.0% vs 46.8%), but the 2017 criteria remain unvalidated in children under 12 years of age [39]. Although there is improved accuracy and sensitivity with these revised criteria, there continues to be misdiagnosis due to overlapping features with numerous mimickers of MS including multiphasic ADEM, NMOSD, vasculitis and other neuroinflammatory diseases, metabolic disorders, and leukodystrophies.…”