MRI and laboratory features and the performance of international criteria in the diagnosis of multiple sclerosis in children and adolescents: a prospective cohort study

Fadda, Giulia; Brown, Robert A.; Longoni, Giulia; Castro, Denise A.; O’Mahony, Julia; Verhey, Leonard H.; Branson, Helen M.; Waters, Patrick; Bar‐Or, Amit; Marrie, Ruth Ann; Yeh, E. Ann; Narayanan, Sridar; Arnold, Douglas L.; Banwell, Brenda; Wambera, Katherine; Connolly, Mary; Yager, Jerome Y.; Mah, Jean K.; Sebire, Giullaume; Callen, David; Meaney, Brandon; Dilenge, Marie-Emmanuelle; Lortie, Anne; Pohl, Daniela; Doja, Asif; Venkateswaran, Sunita; Levin, Simon; Macdonald, Eilidh; Meek, David; Wood, Ellen; Buckley, David; Awuku, Mark; Baird, Janis; Bhan, Virender; Arnaoutelis, Rozie; Nandamalavan, Danusha

doi:10.1016/s2352-4642(18)30026-9

Cited by 106 publications

(93 citation statements)

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“…In particular, future studies should aim to quantify the effect of seropositive-related demyelination on age-expected brain growth and white matter maturation, both of which are negatively affected in MS, 19,[31][32][33] and on cognitive performance. All of this information is essential to better inform the risk-to-benefit ratio of long-term immunosuppression.…”

Section: Discussionmentioning

confidence: 99%

“…Research MRI scans included axial and sagittal T2-weighted images, fluid-attenuated inversion recovery images, T1weighted images, and T1-weighted images after administration of gadolinium. Scans acquired within 45 days of clinical presentation were analyzed by applying a standardized scoring tool 18 modified to include additional MRI variables 19 and blinded to MOG status and to clinical outcome.…”

Section: Mri Analysismentioning

confidence: 99%

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Serial Anti–Myelin Oligodendrocyte Glycoprotein Antibody Analyses and Outcomes in Children With Demyelinating Syndromes

et al. 2020

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Identifying the course of demyelinating disease associated with myelin oligodendrocyte glycoprotein (MOG) autoantibodies is critical to guide appropriate treatment choices. OBJECTIVE To characterize serial anti-MOG antibody serologies and clinical and imaging features at presentation and during follow-up in an inception cohort of prospectively monitored children with acquired demyelination. DESIGN, SETTING, AND PARTICIPANTS In this prospective cohort study, study participants were recruited from July 2004 to February 2017 through the multicenter Canadian Pediatric Demyelinating Disease Study. Inclusion criteria included (1) incident central nervous system demyelination, (2) at least 1 serum sample obtained within 45 days from onset, and (3) complete clinical information. Of 430 participants with acquired demyelinating syndrome recruited, 274 were included in analyses. Of 156 excluded participants, 154 were excluded owing to missing baseline samples and 2 owing to incomplete clinical information. Data were analyzed from May to October 2018. MAIN OUTCOMES AND MEASURES Presence of anti-MOG antibodies was blindly assessed in serial samples collected over a median of 4 years. Clinical, magnetic resonance imaging, and cerebrospinal fluid features were characterized at presentation, and subsequent disease course was assessed by development of new brain magnetic resonance imaging lesions, total lesion volume at last evaluation, annualized relapse rates, Expanded Disability Status Scale score and visual functional score at 4 years, and any disease-modifying treatment exposure. RESULTS Of the 274 included participants, 140 (51.1%) were female, and the median (interquartile range) age of all participants was 10.8 (6.2-13.9) years. One-third of children were positive for anti-MOG antibodies at the time of incident demyelination. Clinical presentations included a combination of optic neuritis, transverse myelitis, and acute disseminated encephalomyelitis for 81 of 84 anti-MOG antibody-positive children (96%). Brain lesions were present in 51 of 76 anti-MOG antibody-positive participants (67%), but magnetic resonance imaging characteristics differed with age at presentation. Complete resolution of baseline lesions was observed in 26 of 49 anti-MOG antibody-positive participants (53%). On serial serum analysis, 38 of 67 participants (57%) who were seropositive at onset became seronegative (median time to conversion, 1 year). Among all participants who were positive for anti-MOG antibodies at presentation, clinical relapses occurred in 9 of 24 children (38%) who remained persistently seropositive and in 5 of 38 children (13%) who converted to seronegative status. CONCLUSIONS AND RELEVANCE Myelin oligodendrocyte glycoprotein antibodies are common in children with acquired demyelinating syndrome and are transient in approximatively half of cases. Even when persistently positive, most anti-MOG antibody-positive children experience a monophasic disease. The presence of anti-MOG antibodies at the time of incident demyelination should...

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Section: Discussionmentioning

confidence: 99%

Section: Mri Analysismentioning

confidence: 99%

Serial Anti–Myelin Oligodendrocyte Glycoprotein Antibody Analyses and Outcomes in Children With Demyelinating Syndromes

et al. 2020

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“…The Canadian Paediatric Demyelinating Disease network has shown that the 2017 McDonald criteria for the diagnosis of MS, when applied at the time of onset, performed well in identifying children and young people with MS. The criteria were also checked in children with acute disseminated encephalomyelitis (ADEM) and myelin oligodendrocyte antibody positive 9 .…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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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.

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“…In this sense, we consider relevant to validate the 2017 criteria in other regions/countries as well as in different age groups, such as children ≤10 years of age, adolescents or patients with lateonset MS. For example, a study assessing the criteria in Korean patients demonstrated similar diagnostic properties as a Dutch study [16,17]. Another study in children aged 0.46-17.87 years showed the 2017 criteria performed well across the studied age span, with presence of OB improving the diagnostic accuracy [18]. These results suggest that if the McDonald criteria are applied to patients presenting with typical symptoms suggestive of MS, they should be valid in any population, always keeping in mind that the diagnosis of MS should be done only when other diseases have been ruled out.…”

Section: To Include or Not To Include Oligoclonal Bands?mentioning

confidence: 76%

Diagnosis of multiple sclerosis: what is changing?

Arrambide

Tintoré

2019

Expert Review of Neurotherapeutics

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MRI and laboratory features and the performance of international criteria in the diagnosis of multiple sclerosis in children and adolescents: a prospective cohort study

Abstract: The Multiple Sclerosis Scientific Research Foundation and The Children's Hospital of Philadelphia.

Cited by 106 publications

References 25 publications

Serial Anti–Myelin Oligodendrocyte Glycoprotein Antibody Analyses and Outcomes in Children With Demyelinating Syndromes

Serial Anti–Myelin Oligodendrocyte Glycoprotein Antibody Analyses and Outcomes in Children With Demyelinating Syndromes

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

Diagnosis of multiple sclerosis: what is changing?

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