Prognostic factors after a first attack of inflammatory CNS demyelination in children

Neuteboom, Rinze F.; Boon, Maartje; Berrevoets, CE Catsman; Vles, Johan S.H.; Gooskens, R. H. J. M.; Stroink, Hans; Vermeulen, R. Jeroen; Rotteveel, J.J.; Ketelslegers, Immy A.; Peeters, Els; Poll-Thé, Bwee Tien; J, Andel; Verrips, Aad; Hintzen, Rogier Q.

doi:10.1212/01.wnl.0000316193.89691.e1

Cited by 124 publications

(119 citation statements)

References 19 publications

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“…A small percentage (≤ 10 %) of patients with ADEM will experience a biphasic course, with a subsequent second attack of ADEM-termed multiphasic ADEM [15,26]. Rarely, ADEM may be followed by monophasic or recurrent optic neuritis and may also precede or follow a diagnosis of anti-N-methyl-D-aspartate (NMDA) receptor encephalitis [27,28].…”

Section: Ademmentioning

confidence: 99%

“…An abnormal brain MRI with clinically silent T2-hyperintense and T1-hypointense lesions at the time of first ADS along with the presence of intrathecal synthesis of oligoclonal bands are also associated with a high likelihood of MS [6,24]. The presence of encephalopathy or a normal brain MRI at the time of ADS (i.e., optic neuritis or transverse myelitis without demyelinating lesions within the brain parenchyma) portends a lower risk of MS [6,25,26]. Additionally, the presence of the HLA-DRB1*1501 allele, remote Epstein-Barr virus infection, and low serum vitamin D appear to be predisposing factors for MS [6].…”

Section: Msmentioning

confidence: 99%

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Therapeutic Approach to the Management of Pediatric Demyelinating Disease: Multiple Sclerosis and Acute Disseminated Encephalomyelitis

Brenton

Banwell

2016

Neurotherapeutics

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Acquired pediatric demyelinating diseases manifest acutely with optic neuritis, transverse myelitis, acute disseminated encephalomyelitis, or with various other acute deficits in focal or polyfocal areas of the central nervous system. Patients may experience a monophasic illness (as in the case of acute disseminated encephalomyelitis) or one that may manifest as a chronic, relapsing disease [e.g., multiple sclerosis (MS)]. The diagnosis of pediatric MS and other demyelinating disorders of childhood has been facilitated by consensus statements regarding diagnostic definitions. Treatment of pediatric MS has been modeled after data obtained from clinical trials in adult-onset MS. There are now an increasing number of new therapeutic agents for MS, and many will be formally studied for use in pediatric patients. There are important efficacy and safety concerns regarding the use of these therapies in children and young adults. This review will discuss acute management as well as chronic immunotherapies in acquired pediatric demyelination.

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Section: Ademmentioning

confidence: 99%

Section: Msmentioning

confidence: 99%

Therapeutic Approach to the Management of Pediatric Demyelinating Disease: Multiple Sclerosis and Acute Disseminated Encephalomyelitis

Brenton

Banwell

2016

Neurotherapeutics

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“…We avoided the use of the term acute disseminated encephalomyelitis because of incomplete consensus on this diagnosis. 12 Hence, we classified the patients with PCIS into 2 subgroups: PCISWOE and PCISWE. Encephalopathy was defined as an altered level of consciousness or change in higher mental status within 3 days of the first demyelinating event unrelated to seizures or antiepileptic treatment.…”

Section: Pcismentioning

confidence: 99%

“…11,12 Using logistic regression, fulfillment of the KIDMUS criteria was significantly associated with conversion to MS (P ϭ .006), but the Barkhof criteria were not (P ϭ .14). The Barkhof criteria demonstrated 60% sensitivity and 76% specificity, while the KIDMUS criteria demonstrated 50% sensitivity and 100% specificity (Table 6).…”

Section: Prediction Of Conversion To Msmentioning

confidence: 99%

“…In addition, MR imaging features, such as the presence of welldefined periventricular and corpus callosum lesions and Barkhof criteria, are specific but insensitive predictors of the development of MS after a first attack in childhood. 11,12 Advanced imaging techniques have not been evaluated in assessing future risk of MS in children with an initial demyelinating event.…”

mentioning

confidence: 99%

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Diffusion Tensor Analysis of Pediatric Multiple Sclerosis and Clinically Isolated Syndromes

Vishwas

Healy

Pienaar

et al. 2012

AJNR Am J Neuroradiol

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Difference in Disease Burden and Activity in Pediatric Patients on Brain Magnetic Resonance Imaging at Time of Multiple Sclerosis Onset vs Adults

Waubant¹,

Chabas²,

Okuda³

et al. 2009

Arch Neurol

165

116

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To compare initial brain magnetic resonance imaging (MRI) characteristics of children and adults at multiple sclerosis (MS) onset. Design: Retrospective analysis of features of first brain MRI available at MS onset in patients with pediatriconset and adult-onset MS. Setting: A pediatric and an adult MS center. Patients: Patients with pediatric-onset Ͻ18 years) and adult-onset (Ն18 years) MS. Main Outcome Measures: We evaluated initial and second (when available) brain MRI scans obtained at the time of first MS symptoms for lesions that were T2-bright, ovoid and well defined, large (Ն1cm), or enhancing. Results: We identified 41 patients with pediatric-onset MS and 35 patients with adult-onset MS. Children had a higher number of total T2-(median, 21 vs 6; PϽ.001) and large T2-bright areas (median, 4 vs 0; PϽ.001) than adults. Children more frequently had T2-bright foci in the posterior fossa (68.3% vs 31.4%; P = .001) and enhancing lesions (68.4% vs 21.2%; PϽ .001) than adults. On the second brain MRI, children had more new T2bright (median, 2.5 vs 0; P Ͻ .001) and gadoliniumenhancing foci (P Ͻ .001) than adults. Except for corpus callosum involvement, race/ethnicity was not strongly associated with disease burden or lesion location on the first scan, although other associations cannot be excluded because of the width of the confidence intervals. Conclusion: While it is unknown whether the higher disease burden, posterior fossa involvement, and rate of new lesions in pediatric-onset MS are explained by age alone, these characteristics have been associated with worse disability progression in adults.

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Prognostic factors after a first attack of inflammatory CNS demyelination in children

Cited by 124 publications

References 19 publications

Therapeutic Approach to the Management of Pediatric Demyelinating Disease: Multiple Sclerosis and Acute Disseminated Encephalomyelitis

Therapeutic Approach to the Management of Pediatric Demyelinating Disease: Multiple Sclerosis and Acute Disseminated Encephalomyelitis

Diffusion Tensor Analysis of Pediatric Multiple Sclerosis and Clinically Isolated Syndromes

Difference in Disease Burden and Activity in Pediatric Patients on Brain Magnetic Resonance Imaging at Time of Multiple Sclerosis Onset vs Adults

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