Magnetic resonance imaging features of the spinal cord in pediatric multiple sclerosis: a preliminary study

Verhey, Leonard H.; Branson, Helen M.; Makhija, Monica; Shroff, Manohar; Banwell, Brenda

doi:10.1007/s00234-010-0755-9

Cited by 54 publications

(53 citation statements)

References 24 publications

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“…In a recent publication, a group from Toronto also found that longitudinally extensive cord lesions occur in paediatric patients with MS [25]. Other investigators have found that short spinal cord lesions can be detected as frequently as longitudinally extensive lesions in AQP4 antibody positive patients [23].…”

Section: Discussionmentioning

confidence: 95%

Diagnosis of neuromyelitis optica (NMO) spectrum disorders: is MRI obsolete?

et al. 2011

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Section: Discussionmentioning

confidence: 95%

Diagnosis of neuromyelitis optica (NMO) spectrum disorders: is MRI obsolete?

et al. 2011

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“…13 The major caveat is the lower specificity of LETM for NMOSD diagnosis in this age group. LETM may be observed in children with MS 14 as well as in children with ADEM 15 and AQP4-IgG is rarely detected in children with monophasic LETM. 16 Thus, further validation of the IPND criteria in children is required.…”

Section: Demographics and Epidemiologymentioning

confidence: 96%

Neuromyelitis optica spectrum disorders in children and adolescents

Tenembaum¹,

Chitnis²,

Nakashima³

et al. 2016

Neurology

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Neuromyelitis optica (NMO) is a severe autoimmune disease of the CNS characterized by recurrent inflammatory events primarily involving the optic nerves and spinal cord. NMO is infrequent in children, but early recognition is important to start adequate treatment. In this article, we review the evolving diagnostic criteria of NMO and provide an update on the clinical and neuroimaging spectrum of the disorder in pediatric patients, including current knowledge on immunopathogenesis and treatment recommendations for children with NMO. Although neuromyelitis optica (NMO) was previously considered a subtype of multiple sclerosis (MS), the identification of autoimmune antibodies (NMO-immunoglobulin G [IgG]) targeted against the aquaporin-4 (AQP4) water channel in the majority of adult patients identified NMO as a different autoimmune disease entity. 1,2The high specificity of AQP4-IgG for NMO has allowed the identification of seropositive patients with atypical presentations of the disease: NMO spectrum disorders (NMOSD). 3Although adults are predominantly affected, NMO/NMOSD has been increasingly recognized in children, who demonstrate a spectrum of disease attacks that often involve CNS areas beyond the optic nerves and spinal cord. 4 A comprehensive update on NMO/NMOSD in the pediatric population is provided in this article. DEMOGRAPHICS AND EPIDEMIOLOGYThe mean age at NMO presentation ranges from 32 to 45 years in major case series. Population-based studies from Europe, Asia, and South America suggest that the incidence of NMO ranges from 0.05 to 4/100,000/y and the prevalence from 0.52 to 4.4/100,000. 5 Nevertheless, most of these studies have not stratified data by pediatric or adult age at onset.5 Pediatric onset is relatively rare.In a comprehensive prevalence study from Cuba, a country with a multiracial population, NMO onset prior to the age of 20 years constituted 3.4% of all NMO cases with an overall prevalence rate of 0.12/100,000 persons. 6 In this study, diagnosis was based on the Wingerchuk et al. 7 1999 criteria, in which AQP4 antibody testing was not included.In a large study of patient samples collected at the Mayo Clinic, 5% of AQP4 antibody-positive patients were children (,18 years), with a mean age at clinical onset of 12 years, a clear female preponderance (7:1), mixed ethnic background, and a poorer prognosis compared with childhood MS. 4 In 3 prospective studies of children with a first demyelinating syndrome, 0.6% (2/302), 8 3.5% (3/86), 9 and 3.7% (3/81) 10 of patients were identified as having NMO over 3-6 years of follow-up. A similar study on 44 children with optic neuritis (ON) reported a final diagnosis of NMO in 7% of patients.

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“…[12][13][14][15][16][17] and have been incorporated into the revised International Pediatric MS Study Group (IPMSSG) 2013 diagnostic criteria for pediatric MS. 18 The spinal cord is 1 of the 4 DIS locations in the McDonald 2010 criteria, although a recent study suggested inclusion of spinal cord imaging at first attack did not improve diagnostic identification of children with MS. 16 In general, spinal lesions in patients with pediatric MS have similar imaging characteristics as those in adult patients. 19 Although most lesions in patients with MS are relatively small, longitudinally extensive lesions spanning greater than 3 spinal segments in length have been described in ADEM and neuromyelitis optica and in up to 10% of patients with pediatric MS. 20 In view of time constraints with sedation and availability of MRI, not all children receive brain and spinal cord MRI at baseline. Including spinal cord MRI can provide a more comprehensive assessment in cases in which there is diagnostic uncertainty and could provide important information for future assessments.…”

Section: Role Of Mri In Ms Diagnosismentioning

confidence: 99%

“…21 However, as of yet, the frequency of clinically silent lesions and the relationship between spinal cord lesions and clinical outcome has not been well-studied in pediatric MS. Given that the majority of spinal lesions in patients with pediatric MS occur in the cervical and thoracic cord, 19 spinal imaging of the cervical and thoracic spine would have the highest diagnostic value.…”

Section: Role Of Mri In Ms Diagnosismentioning

confidence: 99%

MRI in the evaluation of pediatric multiple sclerosis

et al. 2016

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MRI plays a pivotal role in the diagnosis of multiple sclerosis (MS) in children, as it does in adults. The presence of multiple lesions in CNS locations commonly affected by MS, along with the presence of both enhancing and nonenhancing lesions, can facilitate a diagnosis of MS at the time of a first attack, whereas the accrual of serial lesions or new clinical attacks over time confirms the diagnosis in patients not meeting such criteria at onset. T2 and enhancing lesion accrual could serve as a primary outcome metric for pediatric MS clinical trials of selected therapies with anti-inflammatory activity in order to facilitate feasible trial size numbers. More-advanced MRI techniques reveal the impact of MS on tissue integrity within both T2-bright and T1-hypointense lesions and regions of normal-appearing tissue. Volumetric MRI analyses quantify the impact of MS on age-expected brain growth, and fMRI reveals activation and resting-state functional connectivity patterns in patients with pediatric MS that differ from those seen in healthy age-matched youth. Such studies are of critical importance because MS onset during childhood may profoundly influence maturing and actively myelinating neural networks. Highfield MRI visualizes MS pathology at a near-microscopic level and has the potential to more fully explain mechanisms for cognitive impairment, fatigue, and disability in patients with pediatric MS. Multiple sclerosis (MS) in childhood and adolescence is characterized by both clinical and MRI evidence of highly active inflammation. Although many aspects of relapsing-remitting MS (RRMS) are similar in both pediatric-and adult-onset disease, very young pediatric patients have certain unique features. Disorders to consider in the differential diagnosis of MS include non-MS inflammatory diseases, CNS involvement in systemic inflammatory disorders, and genetic and metabolic disorders of white matter, some of which have an associated inflammatory response. MRI forms a key component in evaluation. Pediatric-onset MS also provides a window into understanding the earliest biological aspects of MS. The disease has a great impact on brain integrity, as evidenced by MRI metrics that quantify disruption of tissue microstructure as well as loss of age-expected brain volume. The present article focuses on recent advances in neuroimaging in pediatric MS, with practical considerations for the use of MRI in diagnosis, monitoring of clinical course, and response to therapy. Potential advanced imaging techniques to further understand the impact of the disease on the ongoing maturing CNS are discussed, as is the utility of MRI as an outcome measure for clinical trials in pediatric MS. ROLE OF MRI IN MS DIAGNOSISConsiderable recent effort has focused on the contributions of MRI for distinguishing children with MS from children with monophasic demyelination. Other articles in this supplement provide details regarding the clinical features of incident demyelination, including acute disseminated From The Children's

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Magnetic resonance imaging features of the spinal cord in pediatric multiple sclerosis: a preliminary study

Cited by 54 publications

References 24 publications

Diagnosis of neuromyelitis optica (NMO) spectrum disorders: is MRI obsolete?

Diagnosis of neuromyelitis optica (NMO) spectrum disorders: is MRI obsolete?

Neuromyelitis optica spectrum disorders in children and adolescents

MRI in the evaluation of pediatric multiple sclerosis

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