Oligoclonal bands increase the specificity of MRI criteria to predict multiple sclerosis in children with radiologically isolated syndrome

Abstract

BackgroundSteps towards the development of diagnostic criteria are needed for children with the radiologically isolated syndrome to identify children at risk of clinical demyelination.ObjectivesTo evaluate the 2005 and 2016 MAGNIMS magnetic resonance imaging criteria for dissemination in space for multiple sclerosis, both alone and with oligoclonal bands in cerebrospinal fluid added, as predictors of a first clinical event consistent with central nervous system demyelination in children with radiologically isolated syndrome.MethodsWe analysed an international historical cohort of 61 children with radiologically isolated syndrome (≤18 years), defined using the 2010 magnetic resonance imaging dissemination in space criteria (Ped-RIS) who were followed longitudinally (mean 4.2 ± 4.7 years). All index scans also met the 2017 magnetic resonance imaging dissemination in space criteria.ResultsDiagnostic indices (95% confidence intervals) for the 2005 dissemination in space criteria, with and without oligoclonal bands, were: sensitivity 66.7% (38.4–88.2%) versus 72.7% (49.8–89.3%); specificity 83.3% (58.6–96.4%) versus 53.9% (37.2–69.9%). For the 2016 MAGNIMS dissemination in space criteria diagnostic indices were: sensitivity 76.5% (50.1–93.2%) versus 100% (84.6–100%); specificity 72.7% (49.8–89.3%) versus 25.6% (13.0–42.1%).ConclusionsOligoclonal bands increased the specificity of magnetic resonance imaging criteria in children with Ped-RIS. Clinicians should consider testing cerebrospinal fluid to improve diagnostic certainty. There is rationale to include cerebrospinal fluid analysis for biomarkers including oligoclonal bands in planned prospective studies to develop optimal diagnostic criteria for radiologically isolated syndrome in children.

Current Advances in Pediatric Onset Multiple Sclerosis

“…In children aged 12-17 years old with clinical suspicion of MS, the presence of oligoclonal bands strongly supports a diagnosis [62]. In patients with a pediatric radiologically isolated syndrome, the presence of oligoclonal bands increases the specificity of MRI criteria, and can help in predicting conversion to MS [63]. It is important to note that while oligoclonal bands can be used to make the diagnosis of pediatric MS, other conditions that are classified as mimickers of pediatric MS can also have a presence of oligoclonal bands, thus, this presence does not eliminate other diagnoses.…”

Immune signatures of prodromal multiple sclerosis in monozygotic twins

“…At the time of blood collection, 22 MS-affected cotwins did not receive any DMT, 21 MS-affected cotwins were treated with different DMT, including IFN-β ( n = 14), natalizumab ( n = 4), or glatiramer acetate ( n = 3). MRI and CSF sampling detected subtle signs of inflammation in 10 of 43 clinically healthy cotwins, which was classified as SCNI potentially reflecting prodromal MS in this high-risk cohort (see details in Dataset S1 ) ( 8 , 20 , 48 – 53 ). In order to provide a clear-cut dichotomization of both ends of the spectrum (i.e., healthy vs. SCNI cotwins), healthy cotwins in which MRI-data were missing or inconclusive, and CSF data to either confirm or rule out SCNI was lacking were excluded from this subgroup analysis ( n = 19).…”

Treatment Optimization in Multiple Sclerosis: Canadian MS Working Group Recommendations

“…However, it should be noted that an estimated 50% of individuals with RIS will subsequently develop MS, including PPMS. 13 Predictors of a future clinical event include spinal cord lesions, OCB in the CSF, and demographic factors (male sex, age < 37 years); [13][14][15] MRI lesions demonstrating the "central vein sign" may also have prognostic value. 16 The McDonald criteria can also be used to diagnose POMS.…”