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Updated: Aug 23, 2026
Rat Model of Widespread Cerebral Cortical Demyelination Induced by an Intracerebral Injection of Pro-Inflammatory Cytokines
Published on: September 21, 2021
MRI prognostic factors for relapse after acute CNS inflammatory demyelination in childhood
Yann Mikaeloff1, Catherine Adamsbaum, Béatrice Husson
1Service de Neurologie Pédiatrique, CHU, Angers, France. yann.mikaeloff@free.fr
Abstract:
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.
Insights
Initial MRI findings in children with acute central nervous system (CNS) inflammatory demyelination can predict relapse. Corpus callosum lesions and well-defined lesions are specific predictors of conversion to multiple sclerosis.
Area of Science:
- Pediatric Neurology
- Neuroimmunology
- Radiology
Background:
- Prognostic factors for relapse after a first episode of acute central nervous system (CNS) inflammatory demyelination in children are not well understood.
- Identifying early predictors of disease course is crucial for managing pediatric CNS demyelinating disorders.
Purpose of the Study:
- To identify initial magnetic resonance imaging (MRI) factors that predict a second attack and disability after a first episode of acute CNS inflammatory demyelination in childhood.
- To evaluate the specificity and sensitivity of specific MRI criteria for predicting relapse and conversion to multiple sclerosis.
Main Methods:
- A cohort of 116 children with a first episode of acute CNS inflammatory demyelination was studied using survival analysis.
- Initial MRI data were systematically reviewed in a double-blind manner.
- Follow-up averaged 4.9 years.
Main Results:
- Higher rates of second attack were associated with corpus callosum lesions perpendicular to the long axis (30%) and/or the sole presence of well-defined lesions (40%) on initial MRI.
- These two criteria were highly specific (100%) predictors of relapse and conversion to multiple sclerosis, outperforming the Barkhof criteria (63% specificity).
- However, these specific predictors had lower sensitivity (21%) compared to Barkhof criteria (52%). None of the MRI criteria predicted severe disability.
Conclusions:
- Initial MRI findings, specifically corpus callosum lesions perpendicular to the long axis and well-defined lesions, can predict relapse and conversion to multiple sclerosis in children.
- While these MRI features are specific, their low sensitivity indicates that predicting relapse remains challenging.
- No identified MRI criteria were predictive of severe disability in this pediatric cohort.
