How is pediatric multiple sclerosis (MS) defined?

Updated: Jan 30, 2019
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MS is historically defined as neurologic symptoms disseminated in time (DIT) and space (DIS). The diagnostic criteria for MS in adults have been refined over time. [1, 2, 3] The current McDonald diagnostic criteria may be applied to children if the initial presentation is not characterized by encephalopathy.

MS is a challenging diagnosis in children—especially in prepubescent children—because of the atypical clinical, biological, and MRI presentations and the broader spectrum of potential differential diagnoses specific to that age range. [4]

In 2007, the International Pediatric MS Study Group published operational definitions for acquired demyelinating diseases of the CNS in children. [5] According to these definitions, ADEM (monophasic) requires the presence of both encephalopathy and polysymptomatic presentation. ADEM may last up to 3 months, with fluctuating symptoms or MRI findings. In contrast, a clinically isolated syndrome can be either monofocal or polyfocal but usually does not include encephalopathy. The original definitions were reviewed and updated in 2013. [6]

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