Incidence of paediatric multiple sclerosis and other acquired demyelinating syndromes: 10-year follow-up surveillance study.
Omar Abdel-Mannan, Michael Absoud, Christina Benetou and 6 others
PMID 34693523WHAT IT FOUND
Most children with a first demyelinating episode never relapsed.
Of those who did, almost all met 2017 diagnostic criteria for multiple sclerosis at presentation. Autoantibody testing was inconsistent, missing many cases, and five initial diagnoses were later corrected to other conditions.
Key findings
01Sixty-eight percent of children had a monophasic acute demyelinating syndrome, while twenty-eight percent had a relapsing course.
02Twenty-three of twenty-four patients diagnosed with multiple sclerosis met the revised 2017 McDonald criteria at presentation.
03Five children initially diagnosed with an acquired demyelinating syndrome were found to have alternative diagnoses at ten-year follow-up, including metabolic and autoimmune conditions.
STILL TO COME
How it was doneWhat they found
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What it does not show
Serum MOG and AQP4 antibody testing was not performed systematically at onset, likely underestimating the true prevalence of antibody-associated diseases. Long-term disability outcomes were not measured. Cases were identified through surveillance units, which may miss patients who do not seek specialist care or are managed elsewhere. The study period (2009-2010) predates the widespread clinical availability of MOG antibody testing.
Declared interests
The study was supported by non-US government funding. The text does not list specific financial conflicts of interest for the authors.
The easy way to misread this
Do not assume that a negative antibody test rules out an antibody-mediated disease. Testing was not routine and was often performed late or not at all, meaning many patients with these conditions may have been missed or misclassified.