Radiologically Isolated Syndrome in a Pediatric Patient

George, Ilena C.; DeStefano, Katherine; Makhani, Naila

doi:10.1016/j.pediatrneurol.2015.10.013

Cited by 4 publications

(2 citation statements)

References 3 publications

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“…This clinical scenario, termed the radiologically isolated syndrome (RIS), has been reported in adults and recently in children. [1][2][3][4][5][6] Criteria for RIS in adults were proposed in 2009 and include the incidental detection of MRI abnormalities that meet MRI criteria for dissemination in space as outlined in the 2005 McDonald diagnostic criteria for MS. 7 In one study, approximately 34% of adults who met this definition developed a first clinical event consistent with MS within 5 years. 2 There is uncertainty as to whether the criteria for RIS in adults should also be used for children.…”

Section: Introductionmentioning

confidence: 99%

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

Makhani

Lebrun

Síva

et al. 2019

Multiple Sclerosis Journal - Experimental, Translational and Cl

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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.

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Section: Introductionmentioning

confidence: 99%

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

Makhani

Lebrun

Síva

et al. 2019

Multiple Sclerosis Journal - Experimental, Translational and Cl

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“… 3 We recently reported a teenager with such incidental white matter abnormalities detected on brain MRI. 7 However, outcomes following the detection of RIS in children are not known, and there are no criteria for RIS in children.…”

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confidence: 99%

Radiologically isolated syndrome in children

Makhani¹,

Lebrun²,

Síva³

et al. 2017

Neurol Neuroimmunol Neuroinflamm

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Objective:To describe clinical and radiologic outcomes of children with incidental findings on neuroimaging suggestive of CNS demyelination (termed “radiologically isolated syndrome” or RIS).Methods:Clinical and radiologic data were obtained from a historical cohort of children with no symptoms of demyelinating disease who had MRI scans that met the 2010 MRI criteria for dissemination in space for MS.Results:We identified 38 children (27 girls and 11 boys) with RIS now being prospectively followed at 16 sites in 6 countries. The mean follow-up time was 4.8 ± 5.3 years. The most common reason for initial neuroimaging was headache (20/38, 53%). A first clinical event consistent with CNS demyelination occurred in 16/38 children (42%; 95% confidence interval [CI]: 27%–60%) in a median of 2.0 years (interquartile range [IQR] 1.0–4.3 years). Radiologic evolution developed in 23/38 children (61%; 95% CI: 44%–76%) in a median of 1.1 years (IQR 0.5–1.9 years). The presence of ≥2 unique oligoclonal bands in CSF (hazard ratio [HR] 10.9, 95% CI: 1.4–86.2, p = 0.02) and spinal cord lesions on MRI (HR 7.8, 95% CI: 1.4–43.6, p = 0.02) were associated with an increased risk of a first clinical event after adjustment for age and sex.Conclusions:We describe the clinical characteristics and outcomes of children with incidental MRI findings highly suggestive of CNS demyelination. Children with RIS had a substantial risk of subsequent clinical symptoms and/or radiologic evolution. The presence of oligoclonal bands in CSF and spinal cord lesions on MRI were associated with an increased risk of a first clinical event.

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