Media Releases

Study finds new way to predict MS diagnosis in children

November 10, 2011

Ear­ly MRI scans can help pre­dict the diag­no­sis of mul­ti­ple scle­ro­sis (MS) in chil­dren, which may per­mit ear­li­er ini­ti­a­tion of treat­ment, accord­ing to a new nation­al study.

The study was led by The Hos­pi­tal for Sick Chil­dren (Sick­Kids) and the Uni­ver­si­ty of Toron­to and was per­formed as a part of the Cana­di­an Pedi­atric Demyeli­nat­ing Dis­ease Net­work, a 23-site study that includes all pae­di­atric health-care facil­i­ties in Cana­da. The study is pub­lished in the Nov.7 advance online edi­tion of Lancet Neu­rol­o­gy.

MS is an autoim­mune dis­ease that affects the brain and spinal cord. Peo­ple with MS devel­op lesions (patch­es of inflam­ma­tion in the cen­tral ner­vous sys­tem (CNS)) in which the neu­rons have been stripped of their myelin (insu­lat­ing fat­ty pro­tein).

In this study, the inves­ti­ga­tors cre­at­ed a rig­or­ous scor­ing tool that was applied to mag­net­ic res­o­nance imag­ing (MRI) scans from pae­di­atric patients fol­low­ing their first acute CNS demyeli­nat­ing attack.

An acute CNS demyeli­nat­ing attack could involve a vari­ety of symp­toms, includ­ing loss of vision, tin­gling in low­er limbs, inabil­i­ty to walk, loss of bal­ance or even paral­y­sis. Pre­vi­ous­ly, estab­lished cri­te­ria have required clin­i­cians to wait until the occur­rence of a sec­ond attack to make the diag­no­sis of MS. A sec­ond attack could occur as ear­ly as a month after the ini­tial attack or many years lat­er.

Although the time to a sec­ond attack may take months to years, ongo­ing dis­ease activ­i­ty occurs even between attacks. Iden­ti­fy­ing chil­dren with MS through analy­sis of MRI scans obtained at the first acute attack can lead to rapid diag­no­sis and to an oppor­tu­ni­ty to offer treat­ment even before a sec­ond attack.

U of T pro­fes­sor Bren­da Ban­well of pedi­atrics, prin­ci­pal inves­ti­ga­tor of the study, is a taff neu­rol­o­gist and senior asso­ciate sci­en­tist at Sick­Kids. She not­ed that while MRI has been used on adults in this man­ner, “this is the first time any­one has applied an MRI scor­ing tool to MRI scans from a pop­u­la­tion of at-risk pedi­atric patients. The study demon­strates that there are reli­able MRI fea­tures present at the first clin­i­cal attack that indi­cate that the biol­o­gy of MS is already estab­lished and has been going on for some time.”

The nation­al prospec­tive inci­dence cohort study involved 284 eli­gi­ble chil­dren and teens – of which more than half were Sick­Kids patients – between Sep­tem­ber 2004 and June 2010. More than 1,100 MRI scans were obtained from the par­tic­i­pants. Twen­ty per cent of thechil­dren were diag­nosed with MS 180 days after pre­sent­ing with a first attack. Using the new tech­nique, the sci­en­tists found those patients whose scans revealed two par­tic­u­lar types of lesions, T1-weight­ed hypointense and T2-weight­ed periven­tric­u­lar lesions, were more like­ly to be diag­nosed with MS. Patients with the high­est risk were the ones who had both types of lesions.

“We show that even at the time of the first attack, MRI scans help iden­ti­fy chil­dren with MS,” said Leonard Ver­hey, lead author of the study and a PhD Can­di­date at the Uni­ver­si­ty of Toron­to and Sick­Kids. “Physi­cians can then offer treat­ment designed to reduce the fre­quen­cy of fur­ther attacks.”

Cana­da has one of the world’s high­est rates of MS, affect­ing approx­i­mate­ly one in every 800 Cana­di­ans. There are about 0.9 cas­es of acute CNS demyeli­na­tion per 100,000 Cana­di­an chil­dren per year.

“We are lead­ing as a coun­try in pedi­atric MS research and hope to even­tu­al­ly pro­pose Cana­di­an treat­ment guide­lines for chil­dren pre­sent­ing with MS. The new study is an impor­tant part of a big puz­zle,” said Ban­well, who is also direc­tor of the Pae­di­atric Mul­ti­ple Scle­ro­sis Clin­ic at Sick­Kids.


For more infor­ma­tion, please con­tact:

Matet Nebres
The Hos­pi­tal for Sick Chil­dren

Suzanne Gold
The Hos­pi­tal for Sick Chil­dren
416–813-7654, ext. 2059