Silent findings: Examination of asymptomatic demyelination in a pediatric US cohort.

Autor: Bhise V; Robert Wood Johnson Medical - Rutgers, Pediatrics & Neurology, 89 French Street, Suite 2300, New Brunswick, NJ 08901, USA. Electronic address: bhisevi@rwjms.rutgers.edu., Waltz M; University of Utah, Pediatrics, USA., Casper TC; University of Utah, Pediatrics, USA., Aaen G; Loma Linda University, Neurology, USA., Benson L; Massachusetts General Hospital, Partners Pediatric Multiple Sclerosis Center, Neurology, USA., Chitnis T; Brigham and Women's Hospital, Neurology, USA., Gorman M; Massachusetts General Hospital, Partners Pediatric Multiple Sclerosis Center, USA., Goyal MS; Washington University in Saint Louis, Neurology, USA., Wheeler Y; The University of Alabama at Birmingham School of Medicine Tuscaloosa, Neurology, USA., Lotze T; Texas Childrens Hospital, Child Neurology, USA., Mar S; Washington University St. Louis, Neurology, USA., Rensel M; Cleveland Clinic, Neurology, USA., Abrams A; Cleveland Clinic Neurological Institute, Pediatric Neurology, USA., Rodriguez M; Mayo Clinic, Neurology, USA., Rose J; University of Utah, Neurology, USA., Schreiner T; University of Colorado School of Medicine, Neurology, USA., Shukla N; Texas Children's Hospital, Child Neurology, USA., Waubant E; University of California San Francisco, Regional Pediatric Multiple Sclerosis Center, USA., Weinstock-Guttman B; University at Buffalo - The State University of New York, Pharmaceutical Sciences, USA., Ness J; University of Alabama at Birmingham, Pediatrics, USA., Krupp L; New York University Medical Center, Neurology, USA., Mendelt-Tillema J; Mayo Clinic, Neurology, USA.
Jazyk: angličtina
Zdroj: Multiple sclerosis and related disorders [Mult Scler Relat Disord] 2023 Mar; Vol. 71, pp. 104573. Date of Electronic Publication: 2023 Feb 18.
DOI: 10.1016/j.msard.2023.104573
Abstrakt: Background and Objectives: Limited data is available on children with evidence of silent central nervous system demyelination on MRI. We sought to characterize the population in a US cohort and identify predictors of clinical and radiologic outcomes.
Methods: We identified 56 patients such patients who presented with incidental MRI findings suspect for demyelination, enrolled through our US Network of Pediatric Multiple Sclerosis Centers, and conducted a retrospective review of 38 patients with MR images, and examined risk factors for development of first clinical event or new MRI activity. MRI were rated based on published MS and radiologically isolated syndrome (RIS) imaging diagnostic criteria.
Results: One-third had a clinical attack and ¾ developed new MRI activity over a mean follow-up time of 3.7 years. Individuals in our cohort shared similar demographics to those with clinically definite pediatric-onset MS. We show that sex, presence of infratentorial lesions, T1 hypointense lesions, juxtacortical lesion count, and callosal lesions were predictors of disease progression. Interestingly, the presence of T1 hypointense and infratentorial lesions typically associated with worse outcomes were instead predictive of delayed disease progression on imaging in subgroup analysis. Additionally, currently utilized diagnostic criteria (both McDonald 2017 and RIS criteria) did not provide statistically significant benefit in risk stratification.
Conclusion: Our findings underscore the need for further study to determine if criteria currently used for pediatric patients with purely radiographic evidence of demyelination are sufficient.
(Copyright © 2023 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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