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Can the 2017 McDonald Criteria Diagnose MS in Children?

Applying the new criteria to children may allow earlier diagnosis than the 2010 criteria do.


 

BERLIN—Applying the 2017 McDonald criteria to children is feasible and allows an earlier diagnosis of multiple sclerosis (MS), according to data described at ECTRIMS 2018. The presence of oligoclonal bands and negativity of myelin oligodendrocyte glycoprotein (MOG)-IgG are informative biomarkers when evaluating the risk of MS in children with a first demyelinating event, said the authors.

Few researchers have examined the application of the revised 2017 McDonald criteria to children. In addition, the role of biomarkers in confirming or ruling out a diagnosis of MS is uncertain. Georgina Arrambide, MD, PhD, a neurologist at Vall d’Hebron University Hospital in Barcelona, and colleagues conducted a prospective cohort study to compare the application of the 2017 and 2010 McDonald criteria in children with a first demyelinating event and to evaluate the contribution of biomarkers (ie, oligoclonal bands, aquaporin 4 [AQP4], and MOG-IgG) in predicting their clinical course.

Georgina Arrambide, MD, PhD

The investigators followed a cohort of children from a first demyelinating episode. Serum and CSF samples were taken at fewer than three months from disease onset, and the researchers examined them for oligoclonal bands, AQP4, and MOG-IgG. Dr. Arrambide and colleagues also systematically analyzed 37 MRI items while blinded to clinical and immunologic data. They evaluated the proportion of patients fulfilling the 2010 and the 2017 McDonald criteria at baseline and the contribution of biomarkers to predicting the clinical course.

Clinical and baseline MRI data were available for 55 children (45% female) with a median age of 6.2. About 67% of children were younger than 12. At baseline, the diagnoses according to 2010 McDonald and 2013 International Pediatric MS Study Group criteria were acute disseminated encephalomyelitis (ADEM, 28 patients), MS (three patients), classical clinically isolated syndrome (CIS, 17 patients), radiologically isolated syndrome (RIS, one patient), and other (MRI suggestive of ADEM but without encephalopathy, six patients).

After a median follow-up of 16 months, the diagnosis changed in 10 patients because of clinical (five patients) or radiologic (five patients) activity. Seven patients evolved to MS (six patients with classical CIS and one with RIS), one to relapsing optic neuritis, one to ADEM-ON (ie, ADEM followed by ON), and one to neuromyelitis optica spectrum disorder. None of the seven patients with available baseline samples who evolved to MS had MOG-IgG, compared with 22 of 38 (58%) patients who did not evolve. None had AQP4. In contrast, five of seven (71%) patients with MS had positive oligoclonal bands, compared with one of 26 (4%) who did not develop MS.

At baseline, three of 10 patients fulfilled the 2010 McDonald criteria. Four additional patients fulfilled the 2017 MS criteria thanks to the contribution of oligoclonal bands.

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