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01.01.2016 | Original Paper

Paediatric clinically isolated syndromes: report of seven cases, differential diagnosis and literature review

verfasst von: Chiara Trabatti, Thomas Foiadelli, Maria Valentina Spartà, Chiara Gagliardone, Berardo Rinaldi, Maria Delmonte, Alessandro Lozza, Salvatore Savasta

Erschienen in: Child's Nervous System | Ausgabe 1/2016

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Abstract

Purpose

Few paediatric cases of clinically isolated syndrome (CIS) have been described in literature, even though it has been increasingly recognized also in this age group. Our study retrospectively enrolled seven Italian patients (four males and three females) who met the International Paediatric Multiple Sclerosis Study Group (IPMSSG) 2012 criteria for clinically isolated syndrome over the period 2010–2014; their clinical, laboratory and imaging findings were compared with current literature and with those seen in five patients (three males and two females) with acute disseminated encephalomyelitis, who were followed in our department over the same years (mean follow-up time 2.84 ± 1.8 years).

Results

In our CIS sample, male sex was prevalent, 42.8 % of patients had a multifocal presentation, MRI lesions mostly appeared confluent and with poorly defined margins, and CSF oligoclonal bands (OCBs) were identified in 28.6 %. All acute disseminated encephalomyelitis (ADEM) patients had polyfocal presentation and encephalopathy; large MRI subcortical lesions and polyclonal IgG distribution were identified. During the subsequent follow-up assessments, MRI scan revealed new lesions in three CIS patients, while in ADEM children it appeared normal.

Conclusions

Paediatric CIS patients often show peculiar epidemiological, clinical and radiological features, which significantly differ from adult ones. The presence of encephalopathy and of extended MRI lesions leads to a diagnosis of ADEM, instead. In CIS patients the presence of multiple asymptomatic MRI lesions and of OCBs revealed to be the most predictive risk factors for progression to clinically definite multiple sclerosis (CDMS), so a regular long-term follow-up is recommended; in ADEM, no suitable risk factors for a relapse could be identified.

Miller DH, Chard DT, Ciccarelli O (2012) Clinically isolated syndromes. Lancet Neurol 11:157–69CrossRefPubMed

Krupp LB, Banwell B, Tenembaum S (2007) Consensus definitions proposed for pediatric multiple sclerosis and related disorders. Neurology 68:S7–12CrossRefPubMed

Krupp LB, Tardieu M, Amato MP, Banwell B, Chitnis T, Dale RC et al (2013) International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: revisions to the 2007 definitions. Mult Scler 19:1261–7CrossRefPubMed

Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M et al (2011) Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 69:292–302CrossRefPubMedCentralPubMed

Brownlee WJ, Miller DH (2014) Clinically isolated syndromes and the relationship to multiple sclerosis. J Clin Neurosci

Miller DH, Weinshenker BG, Filippi M, Banwell BL, Cohen JA, Freedman MS et al (2008) Differential diagnosis of suspected multiple sclerosis: a consensus approach. Mult Scler 14:1157–74CrossRefPubMedCentralPubMed

Andersson M, Alvarez-Cermeno J, Bernardi G, Cogato I, Fredman P, Frederiksen J et al (1994) Cerebrospinal fluid in the diagnosis of multiple sclerosis: a consensus report. J Neurol Neurosurg Psychiatry 57:897–902CrossRefPubMedCentralPubMed

Alper G, Heyman R, Wang L (2009) Multiple sclerosis and acute disseminated encephalomyelitis diagnosed in children after long-term follow-up: comparison of presenting features. Dev Med Child Neurol 51:480–6CrossRefPubMedCentralPubMed

Barkhof F, Filippi M, Miller DH, Scheltens P, Campi A, Polman CH et al (1997) Comparison of MRI criteria at first presentation to predict conversion to clinically definite multiple sclerosis. Brain 120(Pt 11):2059–69CrossRefPubMed

10.

Mikaeloff Y, Adamsbaum C, Husson B, Vallee L, Ponsot G, Confavreux C et al (2004) MRI prognostic factors for relapse after acute CNS inflammatory demyelination in childhood. Brain 127:1942–7CrossRefPubMed

11.

Callen DJ, Shroff MM, Branson HM, Lotze T, Li DK, Stephens D et al (2009) MRI in the diagnosis of pediatric multiple sclerosis. Neurology 72:961–7CrossRefPubMed

12.

Verhey LH, Branson HM, Shroff MM, Callen DJ, Sled JG, Narayanan S et al (2011) MRI parameters for prediction of multiple sclerosis diagnosis in children with acute CNS demyelination: a prospective national cohort study. Lancet Neurol 10:1065–73CrossRefPubMed

13.

Sadaka Y, Verhey LH, Shroff MM, Branson HM, Arnold DL, Narayanan S et al (2012) 2010 McDonald criteria for diagnosing pediatric multiple sclerosis. Ann Neurol 72:211–23CrossRefPubMed

14.

Banwell B, Krupp L, Kennedy J, Tellier R, Tenembaum S, Ness J et al (2007) Clinical features and viral serologies in children with multiple sclerosis: a multinational observational study. Lancet Neurol 6:773–781

15.

Haliloglu G, Anlar B, Aysun S, Topcu M, Topaloglu H, Turanli G et al (2002) Gender prevalence in childhood multiple sclerosis and myasthenia gravis. J Child Neurol 17:390–2CrossRefPubMed

16.

Dale RC, Branson JA (2005) Acute disseminated encephalomyelitis or multiple sclerosis: can the initial presentation help in establishing a correct diagnosis? Arch Dis Child 90:636–9CrossRefPubMedCentralPubMed

17.

van Pelt ED, Mescheriakova JY, Makhani N, Ketelslegers IA, Neuteboom RF, Kundu S et al (2013) Risk genes associated with pediatric-onset MS but not with monophasic acquired CNS demyelination. Neurology 81:1996–2001CrossRefPubMed

18.

Wade BJ (2014) Spatial analysis of global prevalence of multiple sclerosis suggests need for an updated prevalence scale. Mult Scler Int 2014:124578PubMedCentralPubMed

19.

O’Gorman C, Broadley SA (2014) Smoking and multiple sclerosis: evidence for latitudinal and temporal variation. J Neurol 261:1677–83CrossRefPubMed

20.

Giovannoni G, Ebers G (2007) Multiple sclerosis: the environment and causation. Curr Opin Neurol 20:261–8CrossRefPubMed

21.

Kakalacheva K, Lunemann JD (2011) Environmental triggers of multiple sclerosis. FEBS Lett 585:3724–9CrossRefPubMed

22.

Langer-Gould A, Brara SM, Beaber BE, Zhang JL (2014) The incidence of clinically isolated syndrome in a multi-ethnic cohort. J Neurol 261:1349–55CrossRefPubMed

23.

Bove R, Chitnis T (2014) The role of gender and sex hormones in determining the onset and outcome of multiple sclerosis. Mult Scler 20:520–6CrossRefPubMed

24.

Andersen O, Lygner PE, Bergstrom T, Andersson M, Vahlne A (1993) Viral infections trigger multiple sclerosis relapses: a prospective seroepidemiological study. J Neurol 240:417–22CrossRefPubMed

25.

Esposito S, Di Pietro GM, Madini B, Mastrolia MV, Rigante D (2015) A spectrum of inflammation and demyelination in acute disseminated encephalomyelitis (ADEM) of children. Autoimmun Rev 14:923–9CrossRefPubMed

26.

Dale RC, Brilot F, Banwell B (2009) Pediatric central nervous system inflammatory demyelination: acute disseminated encephalomyelitis, clinically isolated syndromes, neuromyelitis optica, and multiple sclerosis. Curr Opin Neurol 22:233–40CrossRefPubMed

27.

Bonhomme GR, Mitchell EB (2012) Treatment of pediatric optic neuritis. Curr Treat Options Neurol 14:93–102CrossRefPubMed

28.

Szmyrka-Kaczmarek M, Pokryszko-Dragan A, Pawlik B, Gruszka E, Korman L, Podemski R et al (2012) Antinuclear and antiphospholipid antibodies in patients with multiple sclerosis. Lupus 21:412–20CrossRefPubMed

29.

Garg N, Zivadinov R, Ramanathan M, Vasiliu I, Locke J, Watts K et al (2007) Clinical and MRI correlates of autoreactive antibodies in multiple sclerosis patients. J Neuroimmunol 187:159–65CrossRefPubMed

30.

Thompson AJ, Kermode AG, Moseley IF, MacManus DG, McDonald WI (1993) Seizures due to multiple sclerosis: seven patients with MRI correlations. J Neurol Neurosurg Psychiatry 56:1317–20CrossRefPubMedCentralPubMed

31.

Yeh EA, Chitnis T, Krupp L, Ness J, Chabas D, Kuntz N et al (2009) Pediatric multiple sclerosis. Nat Rev Neurol 5:621–31CrossRefPubMed

32.

Yeh EA (2012) Management of children with multiple sclerosis. Paediatr Drugs 14:165–77CrossRefPubMed

33.

Tumani H (2008) Corticosteroids and plasma exchange in multiple sclerosis. J Neurol 255(Suppl 6):36–42CrossRefPubMed

34.

Dudesek A, Zettl UK (2006) Intravenous immunoglobulins as therapeutic option in the treatment of multiple sclerosis. J Neurol 253(Suppl 5):V50–8CrossRefPubMed

35.

O’Riordan JI, Thompson AJ, Kingsley DP, MacManus DG, Kendall BE, Rudge P et al (1998) The prognostic value of brain MRI in clinically isolated syndromes of the CNS. A 10-year follow-up. Brain 121(Pt 3):495–503CrossRefPubMed

36.

Tintore M, Rovira A, Rio J, Nos C, Grive E, Tellez N et al (2006) Baseline MRI predicts future attacks and disability in clinically isolated syndromes. Neurology 67:968–72CrossRefPubMed

37.

Paolino E, Fainardi E, Ruppi P, Tola MR, Govoni V, Casetta I et al (1996) A prospective study on the predictive value of CSF oligoclonal bands and MRI in acute isolated neurological syndromes for subsequent progression to multiple sclerosis. J Neurol Neurosurg Psychiatry 60:572–5CrossRefPubMedCentralPubMed

38.

Pelayo R, Montalban X, Minoves T, Moncho D, Rio J, Nos C et al (2010) Do multimodal evoked potentials add information to MRI in clinically isolated syndromes? Mult Scler 16:55–61CrossRefPubMed

39.

Mowry EM, Krupp LB, Milazzo M, Chabas D, Strober JB, Belman AL et al (2010) Vitamin D status is associated with relapse rate in pediatric-onset multiple sclerosis. Ann Neurol 67:618–24PubMed

40.

Lunemann JD, Tintore M, Messmer B, Strowig T, Rovira A, Perkal H et al (2010) Elevated Epstein-Barr virus-encoded nuclear antigen-1 immune responses predict conversion to multiple sclerosis. Ann Neurol 67:159–69CrossRefPubMedCentralPubMed

41.

Di Pauli F, Reindl M, Ehling R, Schautzer F, Gneiss C, Lutterotti A et al (2008) Smoking is a risk factor for early conversion to clinically definite multiple sclerosis. Mult Scler 14:1026–30CrossRefPubMed

42.

Mikaeloff Y, Caridade G, Tardieu M, Suissa S (2007) Parental smoking at home and the risk of childhood-onset multiple sclerosis in children. Brain 130:2589–95CrossRefPubMed

43.

Perez-Miralles F, Sastre-Garriga J, Tintore M, Arrambide G, Nos C, Perkal H et al (2013) Clinical impact of early brain atrophy in clinically isolated syndromes. Mult Scler 19:1878–86CrossRefPubMed

44.

Fernando KT, McLean MA, Chard DT, MacManus DG, Dalton CM, Miszkiel KA et al (2004) Elevated white matter myo-inositol in clinically isolated syndromes suggestive of multiple sclerosis. Brain 127:1361–9CrossRefPubMed

45.

Neuteboom RF, Boon M, Catsman Berrevoets CE, Vles JS, Gooskens RH, Stroink H et al (2008) Prognostic factors after a first attack of inflammatory CNS demyelination in children. Neurology 71:967–73CrossRefPubMed

46.

Langer-Gould A, Brara SM, Beaber BE, Koebnick C (2013) Childhood obesity and risk of pediatric multiple sclerosis and clinically isolated syndrome. Neurology 80:548–52CrossRefPubMedCentralPubMed

47.

Kariyawasam S, Singh RR, Gadian J, Lumsden DE, Lin JP, Siddiqui A, Hacohen Y, Absoud M, Lim M (2015) Clinical and radiological features of recurrent demyelination following acute disseminated encephalomyelitis (ADEM). Mult Scler Relat Disord 4:451–6CrossRefPubMed

48.

Julian L, Serafin D, Charvet L, Ackerson J, Benedict R, Braaten E et al (2013) Cognitive impairment occurs in children and adolescents with multiple sclerosis: results from a United States network. J Child Neurol 28:102–7CrossRefPubMedCentralPubMed

49.

Rieckmann P, Toyka KV, Bassetti C, Beer K, Beer S, Buettner U et al (2004) Escalating immunotherapy of multiple sclerosis--new aspects and practical application. J Neurol 251:1329–39CrossRefPubMed

Titel: Paediatric clinically isolated syndromes: report of seven cases, differential diagnosis and literature review
verfasst von: Chiara Trabatti
Thomas Foiadelli
Maria Valentina Spartà
Chiara Gagliardone
Berardo Rinaldi
Maria Delmonte
Alessandro Lozza
Salvatore Savasta
Publikationsdatum: 01.01.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: Child's Nervous System / Ausgabe 1/2016
Print ISSN: 0256-7040
Elektronische ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-015-2959-0

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Paediatric clinically isolated syndromes: report of seven cases, differential diagnosis and literature review