MRI prognostic factors for relapse after acute CNS inflammatory demyelination in childhood.
The prognostic factors for relapse of the initial MRI findings after a first episode of acute CNS inflammatory demyelination are unclear in children. In this study we aimed to identify initial MRI factors that are predictive of a second attack and disability after a first episode of acute CNS inflammatory demyelination in childhood. A cohort of 116 children who had a first episode of acute CNS inflammatory demyelination between 1990 and 2002 was studied using survival analysis methods. The initial MRI data were reviewed in a systematic, standardized, double-blind manner. The average follow-up was 4.9 +/- 3 years. Multivariate analysis showed that the rate of second attack was higher in patients with corpus callosum long axis perpendicular lesions (34 out of 116 patients, 30%) on the initial MRI [hazard ratio (HR) 2.89; 95% confidence interval (CI) 1.65-5.06] and/or with the sole presence of well-defined lesions (46 out of 116 patients, 40%) (HR 1.71; 95% CI 1.29-2.27). Both criteria were more specific predictors (100%) of relapse, demonstrating conversion to multiple sclerosis, than the three Barkhof criteria (63%), but were less sensitive (21% compared with 52%). None of the MRI criteria was predictive of severe disability. Using initial MRI and survival analysis methods, we identified two specific predictors of relapse and conversion to multiple sclerosis after a first episode of acute CNS inflammatory demyelination in childhood. Their low sensitivity, however, shows that this prediction remains difficult.
Mikaeloff
Yann
Y
Service de Neurologie Pédiatrique, CHU, Angers, France. yann.mikaeloff@free.fr
Adamsbaum
Catherine
C
Husson
Béatrice
B
Vallée
Louis
L
Ponsot
Gérard
G
Confavreux
Christian
C
Tardieu
Marc
M
Suissa
Samy
S
D000208:Acute Disease; D000293:Adolescent; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003337:Corpus Callosum / Q000473:pathology; D020278:Demyelinating Autoimmune Diseases, CNS / Q000401:mortality / Q000473:pathology*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000401:mortality / Q000473:pathology; D011379:Prognosis; D012008:Recurrence; D016019:Survival Analysis