Pediatric Radiologically Isolated Syndrome Brings on MS Faster

Naila Makhani, MD, MPH

Completing MRI brain scans on children at a higher risk for developing multiple sclerosis (MS) may indicate earlier diagnoses and treatments, according to a recent report.

Researchers from the Yale School of Medicine examined 38 children in order to describe the clinical and radiologic outcomes of neuroimaging suggesting central nervous system (CNS) demyelination.

The investigators termed this radiologically isolated syndrome (RIS). Currently, there are no formal criteria for the subsequent diagnosis of MS in children or adults with RIS, the researchers said.

“Prior to our study, we did not know how to define the RIS in children or how to counsel families about a child’s risk for MS once this finding was detected,” Naila Makhani, MD, MPH told MD Magazine. “In our study we proposed a working definition of the RIS in children for use in future research studies and for physicians to use in the clinic.”

Included in the study were 27 girls and 11 boys all less than 18 years old, with RIS being monitored at 16 sites in 6 countries. Originally, the children were being scanned for the cause of their headaches; some children also were scanned because of seizure/epilepsy, concussions, or other issues. Each of the patients underwent MRI and at least one MS specialist identified abnormalities on the scans.

All of the children’s MRIs demonstrated dissemination in space, the researchers learned, while at least 1 lesion was detected in each child. Half of the patients even met the definition of RIS in adults.

Within a median period of 2 years, 42% of the children (16 of 38) had their first clinical event consistent with CNS demyelination, the study authors wrote. Of those, 14 had one or more follow up surveillance of brain MRI prior to the onset of clinical MS symptoms. The remaining 2 patients in this group developed clinical symptoms after 1 and 3 months, respectively.

“Our most surprising observation was that children with the RIS who developed the clinical symptoms of MS did so much faster than what had previously been reported in adults,” Makhani said. “To me, this suggests that children with this finding should be monitored closely.”

Five patients were treated with at least one disease modifying therapy for MS before the first clinical event. They were all treated with interferon beta 1a, researchers wrote.

From this study, the researchers learned new information to provide families with about their future risk of MS following RIS.

“Importantly, we identified 2 factors — the presence of oligoclonal bands in spinal fluid and MRI changes in the spinal cord — that substantially increase a child's risk for MS,” Makhani said. “These findings suggest that all children with the RIS should have a comprehensive workup.”

Other studies have found that 34% to 60% of adults with RIS later develop clinical or radiologic evolution, respectively, the researchers added. But in this study, the children had clinical and radiologic evolution faster than the RIS adults. This highlights the importance of detecting RIS in children, the researchers concluded.

The paper, “Radiologically isolated syndrome in children,” was published online in the journal Neurology: Neuroimmunology & Neuroinflammation.

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