title: 2010 McDonald criteria for diagnosing pediatric multiple sclerosis.
abstract: OBJECTIVE
  The diagnosis of multiple sclerosis (MS) rests on confirmation of central nervous system inflammatory disease that is disseminated in space and time, as evidenced clinically or by magnetic resonance imaging (MRI). The 2010 McDonald criteria simplified MRI requirements, and newly proposed that the criteria are also suitable for the diagnosis of pediatric MS.
  
  
  METHODS
  In a national prospective incident cohort study of children with acute demyelination observed for a minimum of 24 months, baseline and serial clinical and MRI examinations were used to retrospectively evaluate the 2010 and 2005 McDonald criteria using clinically relapsing disease as the gold standard.
  
  
  RESULTS
  Of 212 eligible participants, 34 experienced 2 or more clinical attacks, 58 met the 2010 criteria, and 42 met 2005 McDonald criteria. The 2010 criteria demonstrated high sensitivity (100%), specificity (86%), positive predictive value (76%), and negative predictive value (100%) for children older than 11 years with non-acute disseminated encephalomyelitis (ADEM) presentations, as did the 2005 McDonald criteria. In younger children with a non-ADEM presentation, PPV of the 2010 criteria was only 55%. None of the 50 children with ADEM met clinical criteria for MS, but 10 met 2010 and 4 met 2005 criteria.
  
  
  CONCLUSIONS
  Both 2005 and 2010 McDonald criteria identify children with relapsing-remitting MS, although caution is suggested when applying these criteria in younger children. The 2010 McDonald criteria are simple and enable an early diagnosis of MS, but are not suited for application in the context of ADEM-like presentations.
authors.affiliation: Division of Neurology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada.
authors.forename: Yair
authors.initials: Y
authors.lastname: Sadaka
authors.forename: Leonard H
authors.initials: LH
authors.lastname: Verhey
authors.forename: Manohar M
authors.initials: MM
authors.lastname: Shroff
authors.forename: Helen M
authors.initials: HM
authors.lastname: Branson
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Arnold
authors.forename: Sridar
authors.initials: S
authors.lastname: Narayanan
authors.forename: John G
authors.initials: JG
authors.lastname: Sled
authors.forename: Amit
authors.initials: A
authors.lastname: Bar-Or
authors.forename: A Dessa
authors.initials: AD
authors.lastname: Sadovnick
authors.forename: Melissa
authors.initials: M
authors.lastname: McGowan
authors.forename: Ruth Ann
authors.initials: RA
authors.lastname: Marrie
authors.forename: Brenda
authors.initials: B
authors.lastname: Banwell
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002490:Central Nervous System / Q000473:pathology*; D002648:Child; D015331:Cohort Studies; D003937:Diagnosis, Differential; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000592:standards; D008297:Male; D009103:Multiple Sclerosis / Q000175:diagnosis*; D017063:Outcome Assessment, Health Care; D010372:Pediatrics; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors