Paediatric multiple sclerosis: examining utility of the McDonald 2010 criteria

Sedani, Sagar; Lim, Ming; Hemingway, Cheryl; Wassmer, Evangeline; Absoud, Michael

doi:10.1177/1352458511426815

Cited by 22 publications

(24 citation statements)

References 9 publications

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“…44–47 Findings from all studies showed increased sensitivity of the 2010 criteria and indicated that use of the 2010 criteria led to an early diagnosis of multiple sclerosis. In a study of 212 paediatric patients with an acquired demyelinating syndrome, 47 followed prospectively for longer than 2 years with serial clinical and MRI assessments, the sensitivity of the 2010 criteria applied at baseline was 100%, the specificity 86%, the positive predictive value 59%, and the negative predictive value 100% for a subsequent diagnosis of multiple sclerosis.…”

Section: Multiple Sclerosis In Childrenmentioning

confidence: 99%

Multiple sclerosis in children: an update on clinical diagnosis, therapeutic strategies, and research

Waldman¹,

Ghezzi²,

Bar‐Or³

et al. 2014

The Lancet Neurology

131

119

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The clinical features, diagnostic challenges, neuroimaging appearance, therapeutic options, and pathobiological research progress in childhood—and adolescent—onset multiple sclerosis have been informed by many new insights in the past 7 years. National programmes in several countries, collaborative research efforts, and an established international paediatric multiple sclerosis study group have contributed to revised clinical diagnostic definitions, identified clinical features of multiple sclerosis that differ by age of onset, and made recommendations regarding the treatment of paediatric multiple sclerosis. The relative risks conveyed by genetic and environmental factors to paediatric multiple sclerosis have been the subject of several large cohort studies. MRI features have been characterised in terms of qualitative descriptions of lesion distribution and applicability of MRI aspects to multiple sclerosis diagnostic criteria, and quantitative studies have assessed total lesion burden and the effect of the disease on global and regional brain volume. Humoral-based and cell-based assays have identified antibodies against myelin, potassium-channel proteins, and T-cell profiles that support an adult-like T-cell repertoire and cellular reactivity against myelin in paediatric patients with multiple sclerosis. Finally, the safety and efficacy of standard first-line therapies in paediatric multiple sclerosis populations are now appreciated in more detail, and consensus views on the future conduct and feasibility of phase 3 trials for new drugs have been proposed.

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Section: Multiple Sclerosis In Childrenmentioning

confidence: 99%

Multiple sclerosis in children: an update on clinical diagnosis, therapeutic strategies, and research

Waldman¹,

Ghezzi²,

Bar‐Or³

et al. 2014

The Lancet Neurology

131

119

View full text Add to dashboard Cite

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“…This revision to the McDonald criteria enables MS to be diagnosed even earlier in the disease course than does the previous 2005 version, as long as the criteria for dissemination in space are also fulfilled. The 2010 criteria are still being validated but initial reports support their utility (Gomez-Moreno et al, 2012;Sedani et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Moving toward earlier treatment of multiple sclerosis: Findings from a decade of clinical trials and implications for clinical practice

Freedman

Comı

Stefano

et al. 2014

Multiple Sclerosis and Related Disorders

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The first clinical presentation of multiple sclerosis (MS) is usually a single episode of typical symptoms and signs and is designated a "first clinical demyelinating event" (FCDE) or a "clinically isolated syndrome". Patients with an FCDE who show 'silent' magnetic resonance imaging lesions are at high risk of further clinical events and therefore of meeting the criteria for the diagnosis of clinically definite MS (CDMS). Here we review five Phase III trials, in which treatment with the following disease-modifying drugs (DMDs) was initiated at this early stage: interferon beta (ETOMS, CHAMPS, BENEFIT, and REFLEX) and glatiramer acetate (PreCISe). Differences in the design of the trials and their patient inclusion criteria limit comparisons. However, the proportion of placebo-treated patients who developed CDMS within 2 years was 38-45% across studies, and this rate was significantly reduced by DMD treatment. Conversion to McDonald MS was reported by only two of the trials: BENEFIT (2001 criteria) and REFLEX (2005 criteria). Around 85% of placebo-treated patients developed McDonald MS by 2 years in each, and again a beneficial effect of DMD treatment was seen. Overall, these studies support early use of DMDs to treat patients with an FCDE who are at high risk of conversion to CDMS.

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“…The 2012 IPMSSG criteria (but not the Mc Donald 2010 criteria) required an age of 12 years or older for applying DIS and DIT criteria to diagnose MS at the time of the initial CIS. 1 However, subsequent studies [3][4][5][6] found that MS diagnostic criteria at CIS are applicable in younger children, provided that clinicians are aware that 2010 McDonald criteria have a lower positive predictive power and a higher false-positive rate.…”

Section: Evaluations Of 2012 Ipmssg and 2010 Mcdonald Criteria To Diamentioning

confidence: 99%

“…Five reports evaluated the accuracy of the 2010 McDonald criteria to diagnose MS in children, with similar results despite methodologic differences. [3][4][5][6][7] At time of first CIS, after application of the 2010 McDonald criteria to the initial brain MRI, the diagnosis of MS was met in 53%-63% of the children who subsequently developed a clinical relapse. DIT was less frequently present at initial brain MRI than DIS, which was observed in more than 80% of children.…”

Section: Evaluations Of 2012 Ipmssg and 2010 Mcdonald Criteria To Diamentioning

confidence: 99%

“…2 In daily clinical practice, it has not yet been established when it is best to repeat an MRI after a first CIS for clinically stable patients. Two studies on follow-up MRI performed at 3 months 3,6 suggest that this time interval is both efficient (most patients will be recognized) and safe (treatment will not be excessively delayed). As such, we recommend a repeat MRI 3 months after a diagnosis of pediatric CIS.…”

Section: Evaluations Of 2012 Ipmssg and 2010 Mcdonald Criteria To Diamentioning

confidence: 99%

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Consensus definitions for pediatric MS and other demyelinating disorders in childhood

et al. 2016

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In light of the published 2012 International Pediatric Multiple Sclerosis Group definitions for pediatric multiple sclerosis (MS) and related disorders and given that pediatric-onset MS is now formally included in the 2010 McDonald criteria for MS, we sought to review these criteria and summarize their application in children with acquired CNS demyelination. In addition, proposals are made for definitions of no evidence of disease activity and inadequate treatment response that are important because of new therapeutic options and trials. Neurology ® 2016;87 (Suppl 2):S8-S11 GLOSSARY ADEM 5 acute disseminated encephalomyelitis; ARR 5 annualized relapse rate; CIS 5 clinically isolated syndrome; DIS 5 dissemination of inflammatory lesions in space; DIT 5 dissemination of inflammatory lesions in time; EDSS 5 Expanded Disability Status Scale; IPMSSG 5 International Pediatric Multiple Sclerosis Study Group; MOG 5 myelin oligodendroglial glycoprotein; MS 5 multiple sclerosis; NEDA 5 no evidence of disease activity; NMO 5 neuromyelitis optica; RIS 5 radiologically isolated syndrome.The International Pediatric Multiple Sclerosis Study Group (IPMSSG) proposed definitions for pediatric multiple sclerosis (MS), acute disseminated encephalomyelitis (ADEM), neuromyelitis optica (NMO), and clinically isolated syndromes (CIS) to facilitate research providing consistency in terminology.1 In 2012, these definitions were revised to incorporate advances in research and to include components of the 2010 revision of the McDonald criteria.1,2 The cornerstone of a diagnosis of MS, both in adults and children, is the demonstration of dissemination of inflammatory lesions in space (DIS) and in time (DIT) in association with clinical symptoms consistent with acquired CNS demyelination and after the careful exclusion of numerous differential diagnoses. Incorporation of the 2010 McDonald criteria (that in addition to confirming relapsing-remitting MS diagnosis on the basis of new clinical or MRI disease activity over time, also permit MS diagnosis at the time of a first clinical MS attack if the MRI fulfils specific DIS and DIT criteria) to the revised IPMSSG definitions facilitated earlier diagnosis of pediatric MS and provided inclusion criteria for new therapeutic trials (table).Our aim is to review application of the 2012 IPMSSG definitions in pediatric cohorts with acute demyelinating syndromes, discuss clinical scenarios that do not conform to the current definitions, suggest concepts regarding definition of adequate and inadequate treatment responses, and consider future research directions. 3-7 At time of first CIS, after application of the 2010 McDonald criteria to the initial brain MRI, the diagnosis of MS was met in 53%-63% of the children who subsequently developed a clinical relapse. DIT was less frequently present at initial brain MRI than DIS, which was observed in more than 80% of children. Interestingly, the inclusion of spinal cord imaging did not increase accuracy of MS diagnosis. 4,6 A follow-up MRI performed at ...

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Paediatric multiple sclerosis: examining utility of the McDonald 2010 criteria

Cited by 22 publications

References 9 publications

Multiple sclerosis in children: an update on clinical diagnosis, therapeutic strategies, and research

Multiple sclerosis in children: an update on clinical diagnosis, therapeutic strategies, and research

Moving toward earlier treatment of multiple sclerosis: Findings from a decade of clinical trials and implications for clinical practice

Consensus definitions for pediatric MS and other demyelinating disorders in childhood

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