The criteria neurologists use to evaluate multiple sclerosis (MS) in adults may fail to identify the disease in children with suspected imaging, an oversight that may delay treatment for the disease in its early stages, according to a Rutgers study.
Magnetic resonance imaging (MRI) is the primary tool used to diagnose MS, and doctors have applied various criteria over the years to classify people at high risk of developing the disease. The latest standard, known as the McDonald’s Standards, was updated in 2017.
In some cases, imaging suspicious of MS is discovered incidentally before the onset of the disease, a condition known as radiologically isolated syndrome (RIS). But after reviewing the MRI scans of children with RIS, researchers determined that these criteria are likely inadequate for pediatric patients.
In our study, not all patients met the criteria for McDonald or Parkhoff [the current standard for diagnosing adult RIS]Some have gone on to develop MS, said Vikram Pacey, MD, director of pediatric neurology and developmental disabilities at Rutgers Robert Wood Johnson School of Medicine and lead author of the study published in the journal. Multiple sclerosis and related disorders. “This suggests that the criteria used to characterize RIS in adults may be insufficient for the younger population.”
To determine whether children with abnormal MRI results would develop symptoms associated with MS, and to understand how diagnostic tools used for adults apply to children, researchers examined MRI images of children suspected of having demyelination, damage to the protective myelin sheath that It surrounds nerve fibers in the brain.
When the myelin sheath is damaged, nerve impulses slow or stop, causing neurological problems. This damage appears as lesions — white or gray spots — on an MRI. There are many reasons for abnormal MRI results. Most of them do not represent demyelination. While not all patients with typical demyelinating MRI findings develop MS, a significant number do.
Study participants were identified through the US Network of Pediatric Multiple Sclerosis Centers and Rutgers Robert Wood Johnson Medical College databases. The patients were between 7.6 and 17.8 years old, and all had MRI findings that showed demyelination.
None of the children in the study had physical or neurological symptoms common to MS — such as blurring or loss of vision, dizziness, numbness, or weakness in one or both legs — at the time of the initial MRI. While the database didn’t record why participants tested positive, Bhise said headaches were the most common cause.
After the initial review of the MRI data, patient data were evaluated over a mean duration of 3.7 years to measure progression of a first MS attack or new lesions. Of the 38 patients included in the study, 14 of 35 (40 percent) had a new clinical attack and 27 of 37 (73 percent) showed new lesions on MRI during the review period.
When the researchers applied existing diagnostic measures for MS to the group, they found that many patients still had MS despite failing to meet McDonald’s or Parkhof’s criteria.
“Finding MS early can help clinicians address a whole host of future problems for their patients,” said Pace. “But this can only happen with accurate diagnostic tools.”
In the United States, there are an estimated 1 million people living with MS, and about 4,000 people are under the age of 18, according to the MS International Federation, a global network of MS communities.