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Abstract Details

Oligoclonal Bands, Age 11-17 Years, Occipital Lesion, and Female Sex Differentiate Pediatric Multiple Sclerosis from Acute Disseminated Encephalomyelitis: A Nationwide Cohort Study
Child Neurology and Developmental Neurology
S8 - State of the Art Diagnostics in Child Neurology (4:18 PM-4:30 PM)
005

ADEM and MS should be differentiated early because ADEM is monophasic whereas MS is relapsing. Differences exist such as presence of encephalopathy and CSF oligoclonal bands, age at onset, sex and MRI findings; however, these features combined have not been formally tested.

To propose criteria to distinguish multiple sclerosis (MS) from acute disseminated encephalomyelitis (ADEM) at onset based on age at onset, sex, cerebrospinal fluid (CSF) oligoclonal bands and MRI.

A neuroradiologist undertook retrospective evaluation of the baseline MRI in a nationwide cohort of children with medical record-validated MS (n = 67) and monophasic ADEM (n = 46). Children with ADEM had at least 5 years of follow-up for relapse. We used forward stepwise conditional logistic regression to develop our criteria based on age at onset, sex, CSF oligoclonal bands and MRI. We undertook sensitivity analyses using children with ADEM including encephalopathy and polyfocal neurological deficits and in those with onset between 11 and 17 years of age. We estimated accuracy statistics from our criteria and all previously proposed MRI criteria to distinguish MS and ADEM.

The best performing criteria were scoring at least three points in the following categories favoring MS: presence of CSF oligoclonal bands (2 points), occipital lesion (1 point), age 11–17 years (1 point), female sex (1 point). These criteria gave highly reliable discrimination with sensitivity of 95% (95% CI=89%–100%), specificity of 100% (95% CI=100%–100%), and area under the curve of 98% (95% CI=95%–100%). The best performing MRI criteria had area under the curve of 84% (95% CI=78%–91%). Previously proposed MRI criteria had the following areas under the curve: Callen (75%), KIDMUS (82%), and McDonald 2017 criteria (68%).

Combining sex, age at onset, CSF-specific oligoclonal bands and MRI gives highly reliable differentiation between pediatric MS and monophasic ADEM at onset.

Authors/Disclosures
Magnus Spangsberg Boesen (Herlev Hospital)
PRESENTER
Dr. Spangsberg Boesen has nothing to disclose.
No disclosure on file
No disclosure on file
Melinda Magyari Dr. Magyari has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Magyari has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Magyari has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Magyari has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Magyari has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Magyari has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Magyari has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Magyari has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Bristol Myers Squibb. The institution of Dr. Magyari has received research support from The Danish MS Society. The institution of Dr. Magyari has received research support from Biogen. The institution of Dr. Magyari has received research support from Novartis. The institution of Dr. Magyari has received research support from Roche. The institution of Dr. Magyari has received research support from Merck. The institution of Dr. Magyari has received research support from Sanofi.
Morten Blinkenberg (Danish MS Centre, Dept. of Neurology) The institution of Morten Bjorn Blinkenberg, MD, PhD has received research support from Danish MS Society.