Contributions
Abstract: EP1329
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Paediatric MS
Introduction: Multiple Sclerosis (MS) is the main chronic inflammatory central nervous system (CNS) disease. Approximately 10% of MS cases begin at pediatric ages. In these patients, an early diagnosis of MS remains challenging, especially after the first demyelinating event. The International Pediatric Multiple Sclerosis Study Group (IPMSSG) suggested that the fulfillment of the dissemination in space (DIS) and dissemination in time (DIT) of the 2010 McDonald criteria for MS could be applied in children older than 12 years. However, in 2017 the diagnostic criteria of MS in adults was reviewed. Until now, the new criteria were not validated for the pediatric age group.
Objective: to compare the fulfillment of the 2012 IPMSSG criteria and the 2017 McDonald criteria in patients with the first acute demyelinating syndrome (ADS) from the ongoing Brazilian multicentric pediatric cohort.
Methods: Data from patients with ages ranging from zero to 18 years with clinical and radiological evidence of the first ADS were included in a web-based online plataform (Qualtrics®). The fulfillment of MRI criteria for DIS and DIT were evaluated accordingly to the IPMSSG criteria of 2012 and McDonald criteria of 2017.
Results: Twenty-five children with first acute demyelinating syndrome (ADS) (mean age 9.1 years, range 3-202 months, male to female ratio 1.7:1, white to non-white ratio 2.8:1) were evaluated. Most common first ADS were myelitis (34.6%), optic neuritis (30.8%) and ADEM (23.1%). Children younger than 10 years were more likely to present with ADEM (p=0.04). Eleven patients fulfilled the criteria for Clinical Isolated Syndrome (CIS; first ADS suggestive of MS). Of these, 18.1% had radiological evidence of DIS (IPMSSG 2012 radiologic criteria) but no patient had evidence of DIT nor fulfilled the MS IPMSSG criteria. Whereas, 27.2% of the CIS patients (all older than 12 years-old) fulfilled the 2017 McDonald diagnostic criteria for MS.
Conclusion: The 2017 McDonald diagnostic criteria for MS might allow the diagnosis of MS in pediatric patients older than 12 years even after the first clinical event. The long-term follow-up of these patients might help to identify possible caveats and mimics of MS in the pediatric group.
Disclosure: EMOCEMP study has received support from TEVA, FAPERGS, CNPq/Brazil. Bruna Klein da Costa receives scolarship from CNPq/Brazil and received travel grant from Merck. Rafael Canoni Sommer has nothing to disclose. Ricardo Zalewsky has nothing to disclose. Jefferson Becker has received reimbursement for developing educational presentations, educational and research grants, consultations fees and travel stipends from Bayer, Biogen, Ipsen, Merck, Novartis, Roche, Sanofi, Teva. Renata Barbosa Paolilo has received travel grant from Biogen and Roche. José Albino da Paz has nothing to disclose. Dagoberto Callegaro: Research support from CAPES/Brasil (CSF-PAJT88887.091277/2014-00). Fernanda Silveira de Quadros has notjing to disclose. Marlise de Castro Ribeiro has nothing to disclose. Hanaie Cavalli has nothing to disclose. Henry Koiti Sato received grants and consulting fees from Bayer, Biogen, Merck-Serono, TEVA, Sanofi, Genzyme, Roche, Novartis. Douglas K. Sato has received a Grants-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (KAKENHI 15K19472); research support from CNPq/Brasil (425331/2016-4), TEVA (research grant for EMOCEMP Investigator Initiated Study - NCT no. 61080516.4.1001.5336), and Euroimmun AG (Neuroimmunological Complications associated with Arboviruses); and speaker honoraria from Biogen, Novartis, Genzyme, TEVA, Merck-Serono, Roche, Bayer and is an advisory board member of Shire, Roche, TEVA, Merck-Serono and Quest/Athena Diagnostics.
Abstract: EP1329
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Paediatric MS
Introduction: Multiple Sclerosis (MS) is the main chronic inflammatory central nervous system (CNS) disease. Approximately 10% of MS cases begin at pediatric ages. In these patients, an early diagnosis of MS remains challenging, especially after the first demyelinating event. The International Pediatric Multiple Sclerosis Study Group (IPMSSG) suggested that the fulfillment of the dissemination in space (DIS) and dissemination in time (DIT) of the 2010 McDonald criteria for MS could be applied in children older than 12 years. However, in 2017 the diagnostic criteria of MS in adults was reviewed. Until now, the new criteria were not validated for the pediatric age group.
Objective: to compare the fulfillment of the 2012 IPMSSG criteria and the 2017 McDonald criteria in patients with the first acute demyelinating syndrome (ADS) from the ongoing Brazilian multicentric pediatric cohort.
Methods: Data from patients with ages ranging from zero to 18 years with clinical and radiological evidence of the first ADS were included in a web-based online plataform (Qualtrics®). The fulfillment of MRI criteria for DIS and DIT were evaluated accordingly to the IPMSSG criteria of 2012 and McDonald criteria of 2017.
Results: Twenty-five children with first acute demyelinating syndrome (ADS) (mean age 9.1 years, range 3-202 months, male to female ratio 1.7:1, white to non-white ratio 2.8:1) were evaluated. Most common first ADS were myelitis (34.6%), optic neuritis (30.8%) and ADEM (23.1%). Children younger than 10 years were more likely to present with ADEM (p=0.04). Eleven patients fulfilled the criteria for Clinical Isolated Syndrome (CIS; first ADS suggestive of MS). Of these, 18.1% had radiological evidence of DIS (IPMSSG 2012 radiologic criteria) but no patient had evidence of DIT nor fulfilled the MS IPMSSG criteria. Whereas, 27.2% of the CIS patients (all older than 12 years-old) fulfilled the 2017 McDonald diagnostic criteria for MS.
Conclusion: The 2017 McDonald diagnostic criteria for MS might allow the diagnosis of MS in pediatric patients older than 12 years even after the first clinical event. The long-term follow-up of these patients might help to identify possible caveats and mimics of MS in the pediatric group.
Disclosure: EMOCEMP study has received support from TEVA, FAPERGS, CNPq/Brazil. Bruna Klein da Costa receives scolarship from CNPq/Brazil and received travel grant from Merck. Rafael Canoni Sommer has nothing to disclose. Ricardo Zalewsky has nothing to disclose. Jefferson Becker has received reimbursement for developing educational presentations, educational and research grants, consultations fees and travel stipends from Bayer, Biogen, Ipsen, Merck, Novartis, Roche, Sanofi, Teva. Renata Barbosa Paolilo has received travel grant from Biogen and Roche. José Albino da Paz has nothing to disclose. Dagoberto Callegaro: Research support from CAPES/Brasil (CSF-PAJT88887.091277/2014-00). Fernanda Silveira de Quadros has notjing to disclose. Marlise de Castro Ribeiro has nothing to disclose. Hanaie Cavalli has nothing to disclose. Henry Koiti Sato received grants and consulting fees from Bayer, Biogen, Merck-Serono, TEVA, Sanofi, Genzyme, Roche, Novartis. Douglas K. Sato has received a Grants-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (KAKENHI 15K19472); research support from CNPq/Brasil (425331/2016-4), TEVA (research grant for EMOCEMP Investigator Initiated Study - NCT no. 61080516.4.1001.5336), and Euroimmun AG (Neuroimmunological Complications associated with Arboviruses); and speaker honoraria from Biogen, Novartis, Genzyme, TEVA, Merck-Serono, Roche, Bayer and is an advisory board member of Shire, Roche, TEVA, Merck-Serono and Quest/Athena Diagnostics.