Diagnostic Criteria for Pediatric Multiple Sclerosis

Pediatric Neurology (D Nordli, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Pediatric Neurology

Abstract

An estimated 2 % to 5 % of all persons with multiple sclerosis (MS) have onset of symptoms before 16 years of age Krupp and Hertz (Neurology 68(Suppl 2), 2007). As in adults, the diagnosis of pediatric MS is a clinical one, requiring recurrent episodes of CNS demyelination with supportive paraclinical data (MRI findings, CSF characteristics) in the absence of another plausible diagnosis. The differential diagnosis is broad and, the more atypical the case and the younger the child, the more consideration is necessary before making a diagnosis of MS. MS must be differentiated from acute disseminated encephalomyelitis (ADEM) or neuromyelitis optica (NMO). After initial presentation with a CNS demyelinating event or clinically isolated syndrome (CIS), children can meet the diagnostic criteria for MS if serial changes are noted on MRI and other disorders are excluded. Accurate diagnosis of pediatric MS is critical because of the implications of the diagnosis, including the need for long-term disease modifying therapy.

Keywords

Pediatric Children Multiple sclerosis (MS) Demyelinating Diagnosis Diagnostic criteria MRI CSF NMO ADEM 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Krupp LB, Hertz DP. Pediatric multiple sclerosis and related disorders. Neurology. 2007;68(Suppl 2).Google Scholar
  2. 2.
    Chitnes T. Pediatric multiple sclerosis. Neurologist. 2006;12(6):299–310.CrossRefGoogle Scholar
  3. 3.
    •• Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald Criteria. Ann Neurol. 2011;69:292–302. In an effort to improve early diagnosis of MS using clinical and paraclinical data, an international panel of experts created guidelines for the diagnostic criteria of MS referred to as the McDonald Criteria, which were revised in 2005, and then again in 2010. The most recent modifications are intended to be simplified and to apply to a more diverse patient population including children.Google Scholar
  4. 4.
    Krupp LB, Banwell B, Tenembaum S. Consensus definitions proposed for pediatric multiple sclerosis and related disorders. Neurology. 2007;68 Suppl 2:S7–12.PubMedCrossRefGoogle Scholar
  5. 5.
    Hahn JS, Pohl D, Rensel M, et al. Differential diagnosis and evaluation in pediatric multiple sclerosis. Neurology. 2007;68 Suppl 2:S13–22.PubMedCrossRefGoogle Scholar
  6. 6.
    •• Kornek B, Schmitl B, Vass K, Zehetmayer S, Pritsch M, Penzien J, et al. Evaluation of the 2010 McDonald multiple sclerosis criteria in children with a clinically isolated syndrome. Mult Scler. available at http://msj.sagepub.com/content/early/2012/04/23/1352458512444661. Performed retrospective analysis of brain and spine imaging from 52 children with clinically isolated syndrome and assessed sensitivity, specificity, and accuracy of the 2010 McDonald, 2005 McDonald, Callen, KIDMUS, and the Canadian Demyelinating Disease Network criteria.
  7. 7.
    Waldman AT, Gorma MP, Rensel MR. Management of pediatric nervous system demyelinating disorders: consensus of United States Neurologists. J Child Neurol. 2011;26(6):675–82.PubMedCrossRefGoogle Scholar
  8. 8.
    Tenembaum S, Chitnis T, Ness J. Acute disseminated encephalomyelitis. Neurology. 2007;68 Suppl 2:S23–36.PubMedCrossRefGoogle Scholar
  9. 9.
    Banwell B, Tenembaum S, Lennon VA, Ursell E, Kennedy J, Bar-Or A, et al. Neuromyelitis optica-IgG in childhood inflammatory demyelinating CNS disorders. Neurology. 2008;70:344–52.Google Scholar
  10. 10.
    Ness JM, Chabas D, Sadovnick AD, Pohl D, Banwell B, Weinstock-Guttman B. Clinical features of children and adolescents with multiple sclerosis. Neurology. 2007;68 Suppl 2:S37–45.Google Scholar
  11. 11.
    Simone IL, Carrara D, Tortorella C, Liguori M, Lepore V, Pellegrini F, et al. Course and prognosis in early-onset MS: comparison with adult-onset forms. Neurology. 2002;59:1922–8.Google Scholar
  12. 12.
    Jacobs LD, Beck RW, Simon JH, Kinkel RP, Brownscheidle CM, Murray TJ, et al. Intramuscular interferon beta-1a therapy initiated during a first demyelinating event in multiple sclerosis. N Engl J Med. 2000;343:898–904.Google Scholar
  13. 13.
    Comi G, Filippi M, Barkhof F, Giancarlo C, Durelli L, Edan G, et al. Effect of early interferon treatment on conversion to definite multiple sclerosis: a randomized study. Lancet. 2001;357:1576–82.Google Scholar
  14. 14.
    Pohl D, Waubant E, Banwell B, Chabas D, Chitnis T, Weinstock-Guttman B, et al. Treatment of pediatric multiple sclerosis and variants. Neurology. 2007;68 Suppl 2:S54–65.Google Scholar
  15. 15.
    McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin F, et al. Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol. 2001;50:121–7.Google Scholar
  16. 16.
    Polman CH, Reingold SC, Edan G, Filippi M, Hartung HP, Kappos L, et al. Diagnostic criteria for multiple sclerosis: 2005 revisions to the “McDonald Criteria”. Ann Neurol. 2005;58:840–6.Google Scholar
  17. 17.
    •• Sadaka Y, Verhey LH, Shroff MM, Branson HM, Arnold DM, Narayanan S, et al. 2010 McDonald Criteria for diagnosing pediatric multiple sclerosis. Ann Neurol. 2012;72:211–23. The 2010 and 2005 McDonald Criteria were applied to a prospective cohort of pediatric subjects (209 participants) with clinically isolated syndromes of the central nervous system, three-fourths of who had non-ADEM presentations. In this prospective cohort of pediatric subjects with non-ADEM acute demyelinating syndromes the new McDonald criteria were sensitive and specific for the diagnosis of pediatric MS.Google Scholar
  18. 18.
    Callen DJA, Shroff MM, Branson HM, Totze T, Li DK, Stephens D, et al. MRI in the diagnosis of pediatric multiple sclerosis. Neurology. 2009;72:961–7.Google Scholar
  19. 19.
    Mikaeloff Y, Adamsbaum C, Husson B, Vallée L, Ponsot G, Confavreux C, et al. MRI prognostic factors for relapse after acute CNS inflammatory demyelination in children. Brain. 2004;127:1942–7.Google Scholar
  20. 20.
    Verhey LH, Branson HM, Shroff MM, Callen DJA, Sled JG, Narayanan S, et al. MRI parameters for prediction of multiple sclerosis diagnosis in children with acute CNS demyelination: a prospective national cohort study. Lancet Neurol. 2001;10:1065–73.Google Scholar
  21. 21.
    Belman AL, Chitnis T, Renoux C, et al. Challenges in the classification of pediatric multiple sclerosis and future directions. Neurology. 2007;68 Suppl 2:S70–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Chitnis T, Krupp L, Yeh A, Rubin J, Kuntz N, Strober JB, et al. Pediatric multiple sclerosis. Neurol Clin. 2011;29:481–505.Google Scholar
  23. 23.
    Kaye EM. Update on genetic disorders affecting white matter. Pediatr Neurol. 2001;24(1):11–24.PubMedCrossRefGoogle Scholar
  24. 24.
    Shapiro EG, Lockman LA, Knopman D, Krivit W. Characteristics of the dementia in late-onset metachromatic leukodystrophy. Neurology. 1994;44(4):662–5.PubMedCrossRefGoogle Scholar
  25. 25.
    van der Knaap MS, Kamphorst W, Barth PG, Kraaijeveld CL, Gut E, Valk J. Phenotypic variation in leukoencephalopathy with vanishing white matter. Neurology. 1998;51(2):540–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Pridmore CL, Baraitser M, Harding B, Boyd SG, Kendall B, Brett EM. Alexander's disease: clues to diagnosis. J Child Neurol. 1993;8(2):134–44.PubMedCrossRefGoogle Scholar
  27. 27.
    Wallace DC. Mitochondrial diseases in man and mouse. Science. 1999;283(5407):1482–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Mina R, Brunner HI. Pediatric systemic lupus erythematosis. Rheum Dis Clin N Am. 2010;36(1):53–80.CrossRefGoogle Scholar
  29. 29.
    Bauman RJ, Robertson Jr WC. Neurosarcoidosis presents differently in children than in adults. Pediatrics. 2003;112(6):480–6.CrossRefGoogle Scholar
  30. 30.
    Duzova A, Bakkaloglu A. Central nervous system involvement in pediatric rheumatic diseases: current concepts in treatment. Curr Pharm Des. 2008;14:1295–301.PubMedCrossRefGoogle Scholar
  31. 31.
    Goo HW, Weon YC. A spectrum of neuroradiological findings in children with haemophagocytic lymphohistiocytosis. Pediatr Radiol. 2007;37:1110–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Van Rie A, Harrington PR, Dow A, Robertson K. Neurologic and neurodevelopmental manifestations of pediatric HIV/AIDS: a global perspective. Eur J Paediatr Neurol. 2007;11:1–9.PubMedGoogle Scholar
  33. 33.
    Mygland A, Ljostad U, Fingerle V, Rupprecht T, Schmutzhard E, Steiner I. EFNS guidelines on diagnosis and management of European Lyme neuroborreliosis. Eur J Neurol. 2009;17(1):8–e4.PubMedCrossRefGoogle Scholar
  34. 34.
    Oschmann P, Dorndorf W, Hornig C, Schefer C, Wellensilk HJ, Pflughaupt KW. Stages and syndromes of neuroborreliosis. J Neurol. 1998;245:262–72.PubMedCrossRefGoogle Scholar
  35. 35.
    Fernandez RE, Rothberg M, Ferencz G, Wujack D. Lyme disease of the CNS: MR imaging findings in 14 cases. AJNR. 1990;11:479–81.PubMedGoogle Scholar
  36. 36.
    Bitnun A, Ford-Jones E, Blaser S, Richardson S. Mycoplasma pneumoniae encephalitis. Semin Pediatr Infect Dis. 2003;14(2):96–107.PubMedCrossRefGoogle Scholar
  37. 37.
    Chamberlain MC, Gilant ZM, Groves MD, Wilson WH. Diagnostic tools for neoplastic meningitis: detecting disease, identifying patient risk, and determining benefit of treatment. Semin Oncol. 2009;36(4Suppl 2):S35–45.PubMedCrossRefGoogle Scholar
  38. 38.
    Fattapposta F, Restuccia R, Pirro C, Malandrini A, Locuratolo N, Amabile G, et al. Early diagnosis in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL): the role of MRI. Funct Neurol. 2004;19(4):239–42.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Northwestern Feinberg School of MedicineChicagoUSA

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