Contributions
Abstract: P828
Type: Poster
Abstract Category: Clinical aspects of MS - Paediatric MS
Introduction: A first demyelinating event in the central nervous system in children might be the first presentation of paediatric-onset multiple sclerosis (POMS). The Verhey criteria showed high predictive value for POMS in both Canadian and Dutch ADS cohorts. However, in clinical practice one is likely to encounter patients who, at clinical onset, do not fulfill McDonald 2010 criteria and are in addition negative for one or both items of the Verhey criteria. Our aim is to investigate whether OCB may be of additional diagnostic value for predicting clinically definite MS (CDMS) in paediatric patients with acquired demyelinating syndromes (ADS) who are negative for both MRI criteria at incident presentation.
Methods: Children in the Canadian and Dutch prospective ADS databases were eligible for this study if the first MRI and OCB result were both available. MRI scans at onset were evaluated according to the Verhey MRI criteria and the McDonald 2010 MRI criteria. OCB status was tested locally with isoelectric focusing in 109/113 (96%) of cases. A minimal follow-up of two years was required for inclusion, unless the patient was diagnosed with CDMS in this period. Statistical analysis was performed with Chi square, Mann-Whitney U test and the logistic regression model.
Results: One hundred and thirteen ADS patients were included who were negative for both MRI criteria. Fourteen developed CDMS. The CDMS group was significantly older (median age 14.8 years) and had more often OCB positivity than the non-CDMS group (86% vs 13%).
OCB positivity was found in 25/113 of the ADS patients of whom 12/25 (48%) developed CDMS, in contrast to 2/88 (2%) of patients without OCB. The negative predictive value of OCB was high (97%). In a logistic regression model, OCB showed a high odds ratio of 35.3 (95% CI 4.1-307.1, p< 0.000), after correction for the presence of encephalopathy, optic neuritis presenting phenotype, age of onset, gender and abnormal MRI with presence of T2/FLAIR lesions.
Conclusion: OCB in CSF can aid in prediction of POMS in patients who are negative at onset for McDonald 2010 and Verhey MRI criteria. This is most appreciated in patients with a negative OCB status. These patients have a very low risk of MS diagnosis.
Disclosure: YYM Wong: nothing to disclose
LH Verhey: nothing to disclose
ED van Pelt: nothing to disclose
J O"Mahony: nothing to disclose
IA Ketelslegers: nothing to disclose
RF Neuteboom: nothing to disclose
CE Catsman-Berrevoets: nothing to disclose
DL Arnold: nothing to disclose
A Bar-Or: nothing to disclose
BL Banwell: nothing to disclose
RQ Hintzen: nothing to disclose
This study was supported by the Dutch and Canadian Multiple Sclerosis research foundation
Abstract: P828
Type: Poster
Abstract Category: Clinical aspects of MS - Paediatric MS
Introduction: A first demyelinating event in the central nervous system in children might be the first presentation of paediatric-onset multiple sclerosis (POMS). The Verhey criteria showed high predictive value for POMS in both Canadian and Dutch ADS cohorts. However, in clinical practice one is likely to encounter patients who, at clinical onset, do not fulfill McDonald 2010 criteria and are in addition negative for one or both items of the Verhey criteria. Our aim is to investigate whether OCB may be of additional diagnostic value for predicting clinically definite MS (CDMS) in paediatric patients with acquired demyelinating syndromes (ADS) who are negative for both MRI criteria at incident presentation.
Methods: Children in the Canadian and Dutch prospective ADS databases were eligible for this study if the first MRI and OCB result were both available. MRI scans at onset were evaluated according to the Verhey MRI criteria and the McDonald 2010 MRI criteria. OCB status was tested locally with isoelectric focusing in 109/113 (96%) of cases. A minimal follow-up of two years was required for inclusion, unless the patient was diagnosed with CDMS in this period. Statistical analysis was performed with Chi square, Mann-Whitney U test and the logistic regression model.
Results: One hundred and thirteen ADS patients were included who were negative for both MRI criteria. Fourteen developed CDMS. The CDMS group was significantly older (median age 14.8 years) and had more often OCB positivity than the non-CDMS group (86% vs 13%).
OCB positivity was found in 25/113 of the ADS patients of whom 12/25 (48%) developed CDMS, in contrast to 2/88 (2%) of patients without OCB. The negative predictive value of OCB was high (97%). In a logistic regression model, OCB showed a high odds ratio of 35.3 (95% CI 4.1-307.1, p< 0.000), after correction for the presence of encephalopathy, optic neuritis presenting phenotype, age of onset, gender and abnormal MRI with presence of T2/FLAIR lesions.
Conclusion: OCB in CSF can aid in prediction of POMS in patients who are negative at onset for McDonald 2010 and Verhey MRI criteria. This is most appreciated in patients with a negative OCB status. These patients have a very low risk of MS diagnosis.
Disclosure: YYM Wong: nothing to disclose
LH Verhey: nothing to disclose
ED van Pelt: nothing to disclose
J O"Mahony: nothing to disclose
IA Ketelslegers: nothing to disclose
RF Neuteboom: nothing to disclose
CE Catsman-Berrevoets: nothing to disclose
DL Arnold: nothing to disclose
A Bar-Or: nothing to disclose
BL Banwell: nothing to disclose
RQ Hintzen: nothing to disclose
This study was supported by the Dutch and Canadian Multiple Sclerosis research foundation