title: Risk of multiple sclerosis after a first demyelinating syndrome in an Australian Paediatric cohort: clinical, radiological features and application of the McDonald 2010 MRI criteria.
abstract: BACKGROUND
  The risk of multiple sclerosis (MS) is dependent on multiple variables, including geographical location. There is increasing interest in the early recognition and treatment of MS in children.
  
  
  METHODS
  Using univariate and multivariate analysis, we determined the clinical and radiological features that were predictive of MS in 88 children from New South Wales, Australia, with a first acute demyelinating syndrome (ADS) who were followed for a minimum of one year. We tested the McDonald, KIDMUS, Callen and Verhey MRI criteria for paediatric MS.
  
  
  RESULTS
  After a mean follow-up of 5.2 years, 13/88 (15%) of children had MS. Using multivariate analysis, preceding infection was protective of MS, and corpus callosal lesions, the combined presence of both well and poorly demarcated lesions, and contrast-enhancing lesions on MRI were predictive of MS. The sensitivity and specificity of the respective radiological criteria were McDonald 2005 (69%, 68%), McDonald 2010 (58%, 95%), KIDMUS (8%, 100%), Callen (69%, 85%) and Verhey (62%, 84%). When McDonald 2010 criteria were applied to baseline and serial scans, the sensitivity and specificity was 91% and 93%.
  
  
  CONCLUSIONS
  Despite the long follow-up, the risk of MS appears lower in New South Wales children compared to previously reported cohorts. Radiological features are more predictive than clinical features in predicting MS. The McDonald 2010 criteria performed well although the dissemination in time criteria on baseline scans is difficult to apply to children with encephalopathy.
authors.affiliation: Institute for Neuroscience and Muscle Research, The Children's Hospital at Westmead, University of Sydney, Australia.
authors.forename: Esther M
authors.initials: EM
authors.lastname: Tantsis
authors.forename: Kristina
authors.initials: K
authors.lastname: Prelog
authors.forename: Fabienne
authors.initials: F
authors.lastname: Brilot
authors.forename: Russell C
authors.initials: RC
authors.lastname: Dale
mesh_terms: D000293:Adolescent; D001315:Australia / Q000453:epidemiology; D001921:Brain / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003711:Demyelinating Diseases / Q000150:complications* / Q000453:epidemiology*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005843:Geography; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007223:Infant; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009103:Multiple Sclerosis / Q000453:epidemiology* / Q000473:pathology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D055815:Young Adult
keywords: MRI; McDonald 2010 criteria; Multiple sclerosis; acute disseminated encephalomyelitis; clinically isolated syndrome