Contributions
Abstract: 142
Type: Free Communications
Abstract Category: Clinical aspects of MS - Paediatric MS
Objective: We evaluated the performance of the newly proposed 2017 McDonald criteria for the diagnosis of multiple sclerosis (MS) to children at onset of clinical symptoms suggestive of clinically isolated syndrome (CIS) and compared this to the 2010 criteria.
Methods: To identify eligible patients for this study we retrospectively examined a cohort of279 children with acquired demyelinated syndromes with either a follow-up of ³2 years or ³2 recorded clinical attacks. We then excluded all children who presented with acute disseminated encephalomyelitis (N=73) and patients who were myelin oligodendrocyte glycoprotein (N=79) or aquaporin-4 antibody (N=14) positive. The remaining 158 were included in the study. All patients underwent baseline and serial clinical and MRI examinations as part of clinical care (median 8scans, over a median follow-up of 4.2yrs). A neuroradiologist scored the MRI scans acquired at baseline (within 3months from clinical onset). The performance of the 2017 and 2010 McDonald dissemination in space (DIS) and/or in time (DIT) criteria was evaluated.
Results: At baseline, 83/158(53%) and 86/158(54%) children met the 2010 and 2017 DIS criteria, respectively (this modest increase in number was due to the inclusion of lesions within the symptomatic region). At baseline, out of the 59 children who underwent MRI scan with gadolinium, 43(73%) children fulfil the 2010 DIT criteria. When the presence of oligoclonal bands (OCBs) was used to substitute for the requirement of fulfilling DIT, as recommended by the 2017 McDonald criteria, an additional 35 children, who did not meet 2010 DIT criteria at baseline, were diagnosed with MS. The 2017 McDonald criteria had higher accuracy [93.6% vs 66.0%], higher specificity [79.2% (95% CI 68.4-87.0) vs. 54.1% (44.8-63.2)], and similar sensitivity [94.1% (86.8-97.4) vs. 93.6% (82.8-97.8) when compared to 2010 McDonald criteria. No differences were observed when comparing children younger and older than 11yrs.
Conclusion: The improved performance of the 2017 McDonald criteria when compared to 2010 McDonald criteria in children was predominantly due to the inclusion of intrathecal OCBs. In general, an alternative diagnosis should be looked for in children who at CIS onset do not have evidence of intrathecal OCBs. By putting together, the evidence provided by previous studies carried out in adults, our finding suggests that the same criteria could be applied routinely to children at any age.
Disclosure: YH, KM and WKC have nothing to disclose
WJB has received speaker fees from Merck Serono and Roche.EW receiving speaker honoraria and/or travel funding from Biogen, Teva, Genzyme, Shire, UCB, and Merck Serono.
CH received speaking honoraria from Biogen and Terumo and educational grants from Merck Serono, Biogen, and Bayer.
ML received consultation fees from CSL Behring; receiving travel grants from Merck Serono; and receiving educational grants to organize meetings by Novartis, Biogen Idec, Merck Serono and Bayer.
FB acts as a consultant to Biogen-Idec, Janssen Alzheimer Immunotherapy, Bayer-Schering, Merck-Serono, Roche, Novartis, Genzyme, and Sanofi-aventis. He has received sponsorship from EU-H2020, NWO, SMSR, EU-FP7, TEVA, Novartis, Toshiba. He is on the editorial board of Radiology, Brain, Neuroradiology, MSJ, Neurology.
OC receives research funding from UK MS Society, Rosetrees trust and NIHR UCLH BRC. OC serves as a consultant for Biogen, Novartis, Roche, Genzyme, Teva and GE healthcare.
Abstract: 142
Type: Free Communications
Abstract Category: Clinical aspects of MS - Paediatric MS
Objective: We evaluated the performance of the newly proposed 2017 McDonald criteria for the diagnosis of multiple sclerosis (MS) to children at onset of clinical symptoms suggestive of clinically isolated syndrome (CIS) and compared this to the 2010 criteria.
Methods: To identify eligible patients for this study we retrospectively examined a cohort of279 children with acquired demyelinated syndromes with either a follow-up of ³2 years or ³2 recorded clinical attacks. We then excluded all children who presented with acute disseminated encephalomyelitis (N=73) and patients who were myelin oligodendrocyte glycoprotein (N=79) or aquaporin-4 antibody (N=14) positive. The remaining 158 were included in the study. All patients underwent baseline and serial clinical and MRI examinations as part of clinical care (median 8scans, over a median follow-up of 4.2yrs). A neuroradiologist scored the MRI scans acquired at baseline (within 3months from clinical onset). The performance of the 2017 and 2010 McDonald dissemination in space (DIS) and/or in time (DIT) criteria was evaluated.
Results: At baseline, 83/158(53%) and 86/158(54%) children met the 2010 and 2017 DIS criteria, respectively (this modest increase in number was due to the inclusion of lesions within the symptomatic region). At baseline, out of the 59 children who underwent MRI scan with gadolinium, 43(73%) children fulfil the 2010 DIT criteria. When the presence of oligoclonal bands (OCBs) was used to substitute for the requirement of fulfilling DIT, as recommended by the 2017 McDonald criteria, an additional 35 children, who did not meet 2010 DIT criteria at baseline, were diagnosed with MS. The 2017 McDonald criteria had higher accuracy [93.6% vs 66.0%], higher specificity [79.2% (95% CI 68.4-87.0) vs. 54.1% (44.8-63.2)], and similar sensitivity [94.1% (86.8-97.4) vs. 93.6% (82.8-97.8) when compared to 2010 McDonald criteria. No differences were observed when comparing children younger and older than 11yrs.
Conclusion: The improved performance of the 2017 McDonald criteria when compared to 2010 McDonald criteria in children was predominantly due to the inclusion of intrathecal OCBs. In general, an alternative diagnosis should be looked for in children who at CIS onset do not have evidence of intrathecal OCBs. By putting together, the evidence provided by previous studies carried out in adults, our finding suggests that the same criteria could be applied routinely to children at any age.
Disclosure: YH, KM and WKC have nothing to disclose
WJB has received speaker fees from Merck Serono and Roche.EW receiving speaker honoraria and/or travel funding from Biogen, Teva, Genzyme, Shire, UCB, and Merck Serono.
CH received speaking honoraria from Biogen and Terumo and educational grants from Merck Serono, Biogen, and Bayer.
ML received consultation fees from CSL Behring; receiving travel grants from Merck Serono; and receiving educational grants to organize meetings by Novartis, Biogen Idec, Merck Serono and Bayer.
FB acts as a consultant to Biogen-Idec, Janssen Alzheimer Immunotherapy, Bayer-Schering, Merck-Serono, Roche, Novartis, Genzyme, and Sanofi-aventis. He has received sponsorship from EU-H2020, NWO, SMSR, EU-FP7, TEVA, Novartis, Toshiba. He is on the editorial board of Radiology, Brain, Neuroradiology, MSJ, Neurology.
OC receives research funding from UK MS Society, Rosetrees trust and NIHR UCLH BRC. OC serves as a consultant for Biogen, Novartis, Roche, Genzyme, Teva and GE healthcare.