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Reduced brain volumes in children with radiologically isolated syndrome
Georgia Koukou1,2, Frederik Bartels3,4,5,6, Annette Aigner7,8
1Department of Paediatric Neurology, Children's Hospital Datteln, Witten.
Insights
Pediatric radiologically isolated syndrome (RIS) patients show reduced brain volume at diagnosis and over time, similar to pediatric multiple sclerosis (MS). This brain volume reduction in RIS increases the risk of conversion to MS.
Area of Science:
- Neurology
- Pediatric Neurology
- Neuroimaging
Background:
- Pediatric multiple sclerosis (MS) is linked to decreased brain volumes in affected children.
- Early identification of neurological changes in children is crucial for understanding disease progression.
Purpose of the Study:
- To evaluate brain volumes in children diagnosed with radiologically isolated syndrome (RIS) at the time of diagnosis and throughout their clinical course.
- To compare brain volumes in pediatric RIS patients with those of healthy controls and pediatric MS patients.
Main Methods:
- A cohort of 20 pediatric RIS patients and 37 pediatric MS patients were analyzed.
- Brain imaging (MR-imaging) data from RIS patients were compared to healthy controls from the NIH Pediatric MRI Data Repository.
- Clinical data, laboratory findings, and longitudinal volumetric changes were assessed.
Main Results:
- Pediatric RIS patients exhibited reduced whole brain volume (77 cm³ less) compared to healthy controls.
- Longitudinal analysis showed a similar brain volume reduction trajectory in both converting (RIS-to-MS) and non-converting RIS patients compared to controls, mirroring pediatric MS.
- Factors such as oligoclonal bands, CSF pleocytosis, and initial reduced brain volume in RIS correlated with an increased risk of conversion to MS.
Conclusions:
- Reduced whole brain volume is an early characteristic of pediatric radiologically isolated syndrome (RIS).
- The observed brain volume reduction in RIS patients progresses over time, similar to the pattern seen in pediatric multiple sclerosis (MS).
- Identifying specific biomarkers and early imaging findings in RIS can help predict conversion to MS.
Background:
Pediatric multiple sclerosis (MS) is associated with reduced brain volumes at first episode compared to healthy controls.
Objective:
To assess brain volumes in children fulfilling the criteria of radiologically isolated syndrome (RIS) at onset and over time.
Methods:
Clinical course, laboratory findings, MR-imaging in pediatric RIS were compared to controls from the NIH Pediatric MRI Data Repository and a cohort of patients with pediatric MS.
Results:
20 RIS and 37 MS patients were included in the study. Median age at RIS diagnosis was 13.1 years (IQR: 10.3, 14.8) and whole brain volume was reduced by 77 cm3, compared to matched healthy controls (1673 cm3 (1637, 1728) vs 1750 cm3 (1699, 1802)). Nine RIS patients developed MS (RIS-to-MS) at a median age of 15.8 years (12.7,17.0). Longitudinal volumetry revealed lower brain volume in both non-converting and converting RIS patients compared to controls, similar to the trajectory in pediatric MS (RIS -4.7% (-6.5, -2.9), RIS-to-MS -5.1% (-6.9, -3.4), MS -6.6 % (-7.6, -5.5)). Oligoclonal bands, cerebrospinal fluid (CSF) pleocytosis, and reduced brain volume in RIS at diagnosis increased hazards of conversion to MS.
Conclusions:
Reduced whole brain volume is already present in pediatric radiologically isolated syndrome (RIS). Longitudinal analysis of RIS patients revealed reduced brain volume over time, similar to MS.
