[Guide to approaching the first demyelinating event in pediatrics]

Isolated demyelinating syndrome (IDS), or first demyelinating event, is defined as an acute neurological presentation associated with central nervous system (CNS) demyelination. It may occur as a monophasic episode or represent the initial manifestation of a recurrent demyelinating disorder. IDS is classified as either monofocal -affecting the brain, brainstem, cerebellum, optic nerve, or spinal cord-or multifocal, when a combination of these regions is involved. Management is primarily directed toward optimizing functional recovery. Additionally, in patients who fulfill diagnostic criteria for an underlying demyelinating disease, the initiation of immunosuppressive therapy should be considered.