Williams Mitchel T, Tapos Daniela O, Juhász Csaba
Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan; Department of Neurology, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan.
Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan; Department of Neurology, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan.
Pediatr Neurol. 2014 Dec;51(6):826-30. doi: 10.1016/j.pediatrneurol.2014.08.032. Epub 2014 Sep 6.
Pediatric-onset multiple sclerosis represents around 3-5% of all patients with multiple sclerosis. Both the 2005 and 2010 McDonald criteria for multiple sclerosis have been suggested for the possible use in pediatric-onset multiple sclerosis. Modifications incorporated into the 2010 criteria enabled the fulfillment of dissemination in time to be met with the initial magnetic resonance imaging. The present study was designed to compare the diagnostic sensitivity of these criteria at initial presentation, the time to fulfilling them, and secondary effects of ethnicity in pediatric-onset multiple sclerosis.
Twenty-five children with clinically definite multiple sclerosis (mean age, 14.6 ± 3.1 years; 15 girls) from a single center between 2005 and 2012 were analyzed using both the 2005 and 2010 McDonald criteria based on initial clinical presentation and neuroimaging findings comparing diagnostic sensitivity, time interval to meet diagnosis, and ethnicity.
Initial multiple sclerosis diagnosis rates applying the 2005 McDonald criteria were 32% compared with 92% for the 2010 criteria (P = 0.0003). The mean time after initial signs until the 2005 and 2010 McDonald criteria for multiple sclerosis were met was 5.0 vs 0.7 months, respectively (P = 0.001). Time to diagnosis using the 2010 criteria was shorter in black children than the European white (P = 0.005).
The 2010 McDonald criteria are an appropriate tool for the timely diagnosis of pediatric multiple sclerosis, especially in black children, potentially allowing an earlier initiation of disease-modifying therapy.
儿童期多发性硬化症约占所有多发性硬化症患者的3% - 5%。2005年和2010年的多发性硬化症麦克唐纳标准都被建议可用于儿童期多发性硬化症。纳入2010年标准的修订使得初次磁共振成像就能满足时间上的播散性要求。本研究旨在比较这些标准在儿童期多发性硬化症初次就诊时的诊断敏感性、达到诊断标准所需时间以及种族因素的次要影响。
对2005年至2012年间来自单一中心的25名临床确诊为多发性硬化症的儿童（平均年龄14.6 ± 3.1岁；15名女孩），根据初次临床表现和神经影像学结果，采用2005年和2010年麦克唐纳标准进行分析，比较诊断敏感性、达到诊断的时间间隔以及种族。
应用2005年麦克唐纳标准的初次多发性硬化症诊断率为32%，而应用2010年标准的诊断率为92%（P = 0.0003）。初次出现症状后至符合2005年和2010年多发性硬化症麦克唐纳标准的平均时间分别为5.0个月和0.7个月（P = 0.001）。使用2010年标准诊断时，黑人儿童比欧洲白人儿童时间更短（P = 0.005）。
2010年麦克唐纳标准是及时诊断儿童期多发性硬化症的合适工具，尤其是对黑人儿童，可能允许更早开始疾病修饰治疗。
