Incidence of acquired demyelination of the CNS in Canadian children.
BACKGROUND
The incidence of acquired demyelination of the CNS (acquired demyelinating syndromes [ADS]) in children is unknown. It is important that physicians recognize the features of ADS to facilitate care and to appreciate the future risk of multiple sclerosis (MS).


OBJECTIVE
To determine the incidence, clinical features, familial autoimmune history, and acute management of Canadian children with ADS.


METHODS
Incidence and case-specific data were obtained through the Canadian Pediatric Surveillance Program from April 1, 2004, to March 31, 2007. Before study initiation, a survey was sent to all pediatric health care providers to determine awareness of MS as a potential outcome of ADS in children.


RESULTS
Two hundred nineteen children with ADS (mean age 10.5 years, range 0.66-18.0 years; female to male ratio 1.09:1) were reported. The most common presentations were optic neuritis (ON; n = 51, 23%), acute disseminated encephalomyelitis (ADEM; n = 49, 22%), and transverse myelitis (TM; n = 48, 22%). Children with ADEM were more likely to be younger than 10 years, whereas children with monolesional ADS (ON, TM, other) were more likely to be older than 10 years (p < 0.001). There were 73 incident cases per year, leading to an annual incidence of 0.9 per 100,000 Canadian children. A family history of MS was reported in 8%. Before study initiation, 65% of physicians indicated that they considered MS as a possible outcome of ADS in children. This increased to 74% in year 1, 81% in year 2, and 87% in year 3.


CONCLUSIONS
The incidence of pediatric acquired demyelinating syndromes (ADS) is 0.9 per 100,000 Canadian children. ADS presentations are influenced by age.
Banwell
B
B
Research Institute, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, M5G 1X8 Canada. brenda.banwell@sickkids.ca
Kennedy
J
J
Sadovnick
D
D
Arnold
D L
DL
Magalhaes
S
S
Wambera
K
K
Connolly
M B
MB
Yager
J
J
Mah
J K
JK
Shah
N
N
Sebire
G
G
Meaney
B
B
Dilenge
M-E
ME
Lortie
A
A
Whiting
S
S
Doja
A
A
Levin
S
S
MacDonald
E A
EA
Meek
D
D
Wood
E
E
Lowry
N
N
Buckley
D
D
Yim
C
C
Awuku
M
M
Guimond
C
C
Cooper
P
P
Grand'Maison
F
F
Baird
J B
JB
Bhan
V
V
Bar-Or
A
A
D000293:Adolescent; D017677:Age Distribution; D002170:Canada / Q000453:epidemiology; D002493:Central Nervous System Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003710:Demography; D003711:Demyelinating Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D004673:Encephalomyelitis, Acute Disseminated / Q000453:epidemiology; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D015994:Incidence; D007223:Infant; D007275:Injections, Intravenous; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D009188:Myelitis, Transverse / Q000453:epidemiology; D009902:Optic Neuritis / Q000453:epidemiology; D017678:Sex Distribution
D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D008775:Methylprednisolone