Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Jan;19(1):76-86.
doi: 10.1177/1352458512445944. Epub 2012 Apr 19.

Paediatric acquired demyelinating syndromes: incidence, clinical and magnetic resonance imaging features

Michael Absoud  1 , Ming J Lim, Wui K Chong, Christian G De Goede, Katharine Foster, Roxana Gunny, Cheryl Hemingway, Philip E Jardine, Rachel Kneen, Marcus Likeman, Ken K Nischal, Michael G Pike, Naomi A Sibtain, William P Whitehouse, Carole Cummins, Evangeline Wassmer; UK and Ireland Childhood CNS Inflammatory Demyelination Working Group
Collaborators, Affiliations
Free PMC article

Paediatric acquired demyelinating syndromes: incidence, clinical and magnetic resonance imaging features

Michael Absoud et al. Mult Scler. 2013 Jan.
Free PMC article

Abstract

Objective: Changing trends in multiple sclerosis (MS) epidemiology may first be apparent in the childhood population affected with first onset acquired demyelinating syndromes (ADSs). We aimed to determine the incidence, clinical, investigative and magnetic resonance imaging (MRI) features of childhood central nervous system ADSs in the British Isles for the first time.

Methods: We conducted a population active surveillance study. All paediatricians, and ophthalmologists (n = 4095) were sent monthly reporting cards (September 2009-September 2010). International Paediatric MS Study Group 2007 definitions and McDonald 2010 MS imaging criteria were used for acute disseminated encephalomyelitis (ADEM), clinically isolated syndrome (CIS) and neuromyelitis optica (NMO). Clinicians completed a standard questionnaire and provided an MRI copy for review.

Results: Card return rates were 90%, with information available for 200/222 positive notifications (90%). After exclusion of cases, 125 remained (age range 1.3-15.9), with CIS in 66.4%, ADEM in 32.0% and NMO in 1.6%. The female-to-male ratio in children older than 10 years (n = 63) was 1.52:1 (p = 0.045). The incidence of first onset ADS in children aged 1-15 years old was 9.83 per million children per year (95% confidence interval [CI] 8.18-11.71). A trend towards higher incidence rates of ADS in children of South Asian and Black ethnicity was observed compared with White children. Importantly, a number of MRI characteristics distinguished ADEM from CIS cases. Of CIS cases with contrast imaging, 26% fulfilled McDonald 2010 MS diagnostic criteria.

Conclusions: We report the highest surveillance incidence rates of childhood ADS. Paediatric MS diagnosis at first ADS presentation has implications for clinical practice and clinical trial design.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest statement: MA is funded by the MS Society and Action Medical Research charities. CC has been an investigator on research with unrestricted research funding from Eli Lilly, Wyeth and SHS. WKC has nothing to disclose. CDG has attended the Teva Global MS symposium supported by Teva. KF has nothing to disclose. RG has nothing to disclose. CH has received travel grants from Merck Serono and Bayer. PJ has nothing to disclose. RK has nothing to disclose. ML has nothing to disclose. MJL has received educational grants to organise a meeting from Novartis, Biogen Idec, Merck Serono and Bayer. KN has nothing to disclose. MGP has received a meeting support grant from Euroimmun. WPW has nothing to disclose. EW has received travel grants from UCB, Shire and Biogen Idec, educational grants to organize meetings from Merck Sereno, Novartis, Bayer and Biogen Idec, speaker’s fees from Merck Sereno and consultancy fees from Genzyme. All authors are members of the UK & Ireland Childhood CNS Inflammatory Demyelination Working Group.

Figures

Figure 1.
Figure 1.
Study flow chart showing panel review and record linkage outcome.
Figure 2.
Figure 2.
Childhood acquired demyelinating syndromes by age (younger and greater than 10 years old) and sex.
See this image and copyright information in PMC

References

    1. Orton SM, Herrera BM, Yee IM, et al. Sex ratio of multiple sclerosis in Canada: a longitudinal study. Lancet Neurol 2006; 5: 932–936 - PubMed
    1. Koch-Henriksen N, Sorensen PS. The changing demographic pattern of multiple sclerosis epidemiology. Lancet Neurol 2010; 9: 520–532 - PubMed
    1. Renoux C, Vukusic S, Mikaeloff Y, et al. Natural history of multiple sclerosis with childhood onset. N Engl J Med 2007; 356: 2603–2613 - PubMed
    1. Krupp LB, Banwell B, Tenembaum S. Consensus definitions proposed for pediatric multiple sclerosis and related disorders. Neurology 2007; 68: S7–S12 - PubMed
    1. Dean G, Elian M. Age at immigration to England of Asian and Caribbean immigrants and the risk of developing multiple sclerosis. J Neurol Neurosurg Psychiatry 1997; 63: 565–568 - PMC - PubMed

Publication types

LinkOut - more resources