A Long-Term Follow-Up Study Using IPMSSG Criteria in Children With CNS Demyelination

• Published in: Pediatric neurology 2013-11, Vol.49 (5), p.329-334
• Main Authors: Peche, Shubhangi S., MD, Alshekhlee, Amer, MD, MS, Kelly, James, MD, Lenox, Jason, MS, Mar, Soe, MD
• Format: Article
• Language: English
• Subjects: Adolescent; Callen MRI criteria; Child; Child, Preschool; demyelination; Encephalomyelitis, Acute Disseminated - cerebrospinal fluid; Encephalomyelitis, Acute Disseminated - diagnosis; Female; Humans; IPMSSG (International pediatric multiple sclerosis study group); Logistic Models; Longitudinal Studies; Magnetic Resonance Imaging; Male; MS (multiple sclerosis); Multiple Sclerosis - cerebrospinal fluid; Multiple Sclerosis - diagnosis; Neurologic Examination; Neurology; Oligoclonal Bands - cerebrospinal fluid; Pediatrics; Predictive Value of Tests; Retrospective Studies; Sensitivity and Specificity
• ISSN: 0887-8994; 1873-5150
• DOI: 10.1016/j.pediatrneurol.2013.06.023

Abstract Objective To evaluate the practical application of International Pediatrics Multiple Sclerosis study group definitions in children with inflammatory demyelination of the central nervous system and to identify predictors of multiple sclerosis. Methods Baseline data on 123 children with a first episode of acute central nervous system demyelination were collected. The initial diagnosis according to the International Pediatrics Multiple Sclerosis study group was recorded and compared with final diagnosis. Results Forty-seven (38.2%) children met International Pediatrics Multiple Sclerosis study group criteria for acute disseminated encephalomyelitis and 67 (54.4%) had clinically isolated syndrome at the initial presentation. Four (3.2%) had the diagnosis of neuromyelitis optica and five (4%) did not meet any specific diagnosis per the study group criteria. Clinical follow-up was available on 118 of 123 children (95.9%), with a median of 61.5 months (quartile range 23, 110 months). Conversion from clinically isolated syndrome to multiple sclerosis occurred in 26 of 67 children (38.8%); acute disseminated encephalomyelitis to multiple sclerosis occurred in 4 of 47 children (8.5%). Adjusted multivariate logistic regression analysis for an outcome of future development of multiple sclerosis showed the following predictors: female gender (odds ratio 12.44; 95% confidence interval 1.03-149.3); initial diagnosis of monofocal brain stem or hemispheric dysfunction (odds ratio 24.57; 95% confidence interval 3.06-196.78); and Callen magnetic resonance imaging criteria if met (odds ratio 122.45; 95% confidence interval 16.57-904.57). Conclusion International Pediatrics Multiple Sclerosis study group criteria affirm that children with initial clinically isolated syndrome are more likely to develop future multiple sclerosis compared with those with an acute disseminated encephalomyelitis initial diagnosis. In addition, female gender, brain stem or hemispheric involvement, and Callen magnetic resonance imaging criteria predict the diagnosis of multiple sclerosis.