Paediatric acquired demyelinating syndromes: incidence, clinical and magnetic resonance imaging features
Multiple Sclerosis Journal, 05/09/2012
Absoud M et al. – The authors report the highest surveillance incidence rates of childhood acquired demyelinating syndromes (ADSs). Paediatric multiple sclerosis (MS) diagnosis at first ADS presentation has implications for clinical practice and clinical trial design.Methods
- The authors conducted a population active surveillance study.
- All paediatricians, and ophthalmologists (n=4095) were sent monthly reporting cards (September 2009-September 2010).
- International Paediatric MS Study Group 2007 definitions and McDonald 2010 MS imaging criteria were used for acute disseminated encephalomyelitis (ADEM), clinically isolated syndrome (CIS) and neuromyelitis optica (NMO).
- Clinicians completed a standard questionnaire and provided an MRI copy for review.
- Card return rates were 90%, with information available for 200/222 positive notifications (90%).
- After exclusion of cases, 125 remained (age range 1.3-15.9), with CIS in 66.4%, ADEM in 32.0% and NMO in 1.6%.
- The female-to-male ratio in children older than 10 years (n=63) was 1.52:1 (p=0.045).
- The incidence of first onset ADS in children aged 1-15 years old was 9.83 per million children per year (95% confidence interval [CI] 8.18-11.71).
- A trend towards higher incidence rates of ADS in children of South Asian and Black ethnicity was observed compared with White children.
- Importantly, a number of MRI characteristics distinguished ADEM from CIS cases.
- Of CIS cases with contrast imaging, 26% fulfilled McDonald 2010 MS diagnostic criteria.