Oligoclonal bands increase the specificity of MRI criteria to predict multiple sclerosis in children with radiologically isolated syndrome

Naila Makhani*, Christine Lebrun, Observatoire Francophone de la Sclérose en Plaques (OFSEP), Radiologically Isolated Syndrome Consortium (RISC), Pediatric Radiologically Isolated Syndrome Consortium (PARIS), Aksel Siva, Sona Narula, Evangeline Wassmer, David Brassat, J. Nicholas Brenton, Philippe Cabre, Clarisse Carra Dallière, Jérôme De Seze, Francoise Durand Dubief, Matilde Inglese, Megan Langille, Guillaume Mathey, Rinze F. Neuteboom, Jean Pelletier, Daniela PohlDaniel S. Reich, Juan Ignacio Rojas, Veronika Shabanova, Eugene D. Shapiro, Robert T. Stone, Silvia Tenembaum, Mar Tintoré, Ugur Uygunoglu, Wendy Vargas, Sunita Venkateswaren, Patrick Vermersch, Orhun Kantarci, Darin T. Okuda, Daniel Pelletier

*Corresponding author for this work

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Abstract

Background: Steps towards the development of diagnostic criteria are needed for children with the radiologically isolated syndrome to identify children at risk of clinical demyelination. Objectives: To evaluate the 2005 and 2016 MAGNIMS magnetic resonance imaging criteria for dissemination in space for multiple sclerosis, both alone and with oligoclonal bands in cerebrospinal fluid added, as predictors of a first clinical event consistent with central nervous system demyelination in children with radiologically isolated syndrome. Methods: We analysed an international historical cohort of 61 children with radiologically isolated syndrome (≤18 years), defined using the 2010 magnetic resonance imaging dissemination in space criteria (Ped-RIS) who were followed longitudinally (mean 4.2 ± 4.7 years). All index scans also met the 2017 magnetic resonance imaging dissemination in space criteria. Results: Diagnostic indices (95% confidence intervals) for the 2005 dissemination in space criteria, with and without oligoclonal bands, were: Sensitivity 66.7% (38.4–88.2%) versus 72.7% (49.8–89.3%); specificity 83.3% (58.6–96.4%) versus 53.9% (37.2–69.9%). For the 2016 MAGNIMS dissemination in space criteria diagnostic indices were: Sensitivity 76.5% (50.1–93.2%) versus 100% (84.6–100%); specificity 72.7% (49.8–89.3%) versus 25.6% (13.0–42.1%). Conclusions: Oligoclonal bands increased the specificity of magnetic resonance imaging criteria in children with Ped-RIS. Clinicians should consider testing cerebrospinal fluid to improve diagnostic certainty. There is rationale to include cerebrospinal fluid analysis for biomarkers including oligoclonal bands in planned prospective studies to develop optimal diagnostic criteria for radiologically isolated syndrome in children.

Original languageEnglish
JournalMultiple Sclerosis Journal - Experimental, Translational and Clinical
Volume5
Issue number1
DOIs
Publication statusPublished - 2019

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: N Makhani was supported by a Junior Investigator Award from Race to Erase MS. This publication was made possible, in part, by CTSA grant number UL1 TR000142 from the National Center for Advancing Translational Science (NCATS) and grant number K23NS101099 from the National Institute of Neurological Disorders and Stroke (NINDS) at the National Institutes of Health (NIH) and NIH roadmap for Medical Research, as well as the Intramural Research Program of NINDS. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

Publisher Copyright:
© The Author(s), 2019.

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