Diagnostic Criteria for Pediatric Multiple Sclerosis
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.
KeywordsPediatric Children Multiple sclerosis (MS) Demyelinating Diagnosis Diagnostic criteria MRI CSF NMO ADEM
Conflict of Interest
Jennifer P. Rubin declares that she has no conflict of interest.
Nancy L. Kuntz declares that she has no conflict of interest.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Krupp LB, Hertz DP. Pediatric multiple sclerosis and related disorders. Neurology. 2007;68(Suppl 2).Google Scholar
- 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
- 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.
- 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.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.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.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.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.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.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.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.•• 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.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.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.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
- 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