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Brain Advance Access originally published online on August 2, 2004
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Brain, Vol. 127, No. 9, 1942-1947, September 2004
© 2004 Guarantors of Brain
doi: 10.1093/brain/awh218

MRI prognostic factors for relapse after acute CNS inflammatory demyelination in childhood

Yann Mikaeloff1, Catherine Adamsbaum2, Béatrice Husson4, Louis Vallée6, Gérard Ponsot3, Christian Confavreux7, Marc Tardieu5, Samy Suissa8 and the KIDMUS Study Group on Radiology*

1 Service de Neurologie Pédiatrique, CHU, Angers, Services de 2 Radiologie and 3 Neurologie Pédiatrique, Hôpital Cochin-Saint-Vincent de Paul, AP-HP, Paris, Services de 4 Radiologie and 5 Neurologie Pédiatrique, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, 6 Service de Neurologie Pédiatrique, Hôpital Roger Salengro, Lille, 7 Service de Neurologie A, Hôpital Neurologique and EDMUS Coordinating Center, Lyon, France and 8 Division of Clinical Epidemiology, McGill University and Royal Victoria Hospital, Montreal, Canada

Correspondence to: Dr Yann Mikaeloff, MD, Service de Neurologie Pédiatrique, Centre Hospitalier Universitaire d'Angers, 4 rue Larrey, 49933 Angers Cedex 9, France E-mail: yann.mikaeloff{at}free.fr

The prognostic factors for relapse of the initial MRI findings after a first episode of acute CNS inflammatory demyelination are unclear in children. In this study we aimed to identify initial MRI factors that are predictive of a second attack and disability after a first episode of acute CNS inflammatory demyelination in childhood. A cohort of 116 children who had a first episode of acute CNS inflammatory demyelination between 1990 and 2002 was studied using survival analysis methods. The initial MRI data were reviewed in a systematic, standardized, double-blind manner. The average follow-up was 4.9 ± 3 years. Multivariate analysis showed that the rate of second attack was higher in patients with corpus callosum long axis perpendicular lesions (34 out of 116 patients, 30%) on the initial MRI [hazard ratio (HR) 2.89; 95% confidence interval (CI) 1.65–5.06] and/or with the sole presence of well-defined lesions (46 out of 116 patients, 40%) (HR 1.71; 95% CI 1.29–2.27). Both criteria were more specific predictors (100%) of relapse, demonstrating conversion to multiple sclerosis, than the three Barkhof criteria (63%), but were less sensitive (21% compared with 52%). None of the MRI criteria was predictive of severe disability. Using initial MRI and survival analysis methods, we identified two specific predictors of relapse and conversion to multiple sclerosis after a first episode of acute CNS inflammatory demyelination in childhood. Their low sensitivity, however, shows that this prediction remains difficult.


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