title: Difference in disease burden and activity in pediatric patients on brain magnetic resonance imaging at time of multiple sclerosis onset vs adults.
abstract: OBJECTIVE
  To compare initial brain magnetic resonance imaging (MRI) characteristics of children and adults at multiple sclerosis (MS) onset.
  
  
  METHODS
  Retrospective analysis of features of first brain MRI available at MS onset in patients with pediatric-onset and adult-onset MS.
  
  
  METHODS
  A pediatric and an adult MS center.
  
  
  METHODS
  Patients with pediatric-onset <18 years) and adult-onset (> or =18 years) MS.
  
  
  METHODS
  We evaluated initial and second (when available) brain MRI scans obtained at the time of first MS symptoms for lesions that were T2-bright, ovoid and well defined, large (> or =1cm), or enhancing.
  
  
  RESULTS
  We identified 41 patients with pediatric-onset MS and 35 patients with adult-onset MS. Children had a higher number of total T2- (median, 21 vs 6; P < .001) and large T2-bright areas (median, 4 vs 0; P < .001) than adults. Children more frequently had T2-bright foci in the posterior fossa (68.3% vs 31.4%; P = .001) and enhancing lesions (68.4% vs 21.2%; P < .001) than adults. On the second brain MRI, children had more new T2-bright (median, 2.5 vs 0; P < .001) and gadolinium-enhancing foci (P < .001) than adults. Except for corpus callosum involvement, race/ethnicity was not strongly associated with disease burden or lesion location on the first scan, although other associations cannot be excluded because of the width of the confidence intervals.
  
  
  CONCLUSIONS
  While it is unknown whether the higher disease burden, posterior fossa involvement, and rate of new lesions in pediatric-onset MS are explained by age alone, these characteristics have been associated with worse disability progression in adults.
authors: UCSF Regional Pediatric Multiple Sclerosis Center, 350 Parnassus Ave, Ste 908, San Francisco, CA 94117, USA. emmanuelle.waubant@ucsf.edu
authors: Emmanuelle
authors: E
authors: Waubant
authors: Dorothee
authors: D
authors: Chabas
authors: Darin T
authors: DT
authors: Okuda
authors: Orit
authors: O
authors: Glenn
authors: Ellen
authors: E
authors: Mowry
authors: Roland G
authors: RG
authors: Henry
authors: Jonathan B
authors: JB
authors: Strober
authors: Bruno
authors: B
authors: Soares
authors: Max
authors: M
authors: Wintermark
authors: Daniel
authors: D
authors: Pelletier
mesh_terms: D017668:Age of Onset; D001921:Brain / Q000473:pathology*; D002648:Child; D017281:Cost of Illness; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000473:pathology; D012189:Retrospective Studies