By the time multiple sclerosis (MS) is diagnosed in children, it may be difficult to prevent the disabilities and relapses that come with the disease. In a new Yale School of Medicine study, researchers looked at MRI brain scans of children with no MS symptoms but who were at high risk of developing the disease, which could lead to earlier diagnosis and treatment.
The study, published in the November issue of the journal Neurology: Neuroimmunology & Neuroinflammation, showed that the MRIs can reveal changes in a child's brain associated with MS before the clinical symptoms of the disease appear. Researchers examined 38 children at 16 sites in six countries.
The children in the study had MRI scans for other reasons, most commonly headache, but the MRIs unexpectedly revealed signs of MS. MRI findings of MS without symptoms is called radiologically isolated syndrome (RIS), and previously doctors had only seen this in adults.
"For the first time we have proposed a definition of RIS in children," says Naila Makhani, M.D., the study's lead author and assistant professor of pediatrics and neurology at Yale School of Medicine. "Children with RIS may represent a high-risk group that needs to be followed more closely for the later development of clinical multiple sclerosis."
Approximately 42 percent of children in the study with MRI findings of MS developed the first clinical symptoms of the disease two years after the abnormal MRI, which shows a faster development of the disease than has been reported in adults. Children who had a specific marker in spinal fluid, or who had MRI changes in the spinal cord, were at greatest risk of developing the clinical symptoms of MS.
Makhani says five of the children in the study received an approved treatment for multiple sclerosis to try to prevent the disease. This number is too small to accurately draw conclusions about the effect of treatment, she says.
"We hope that our work will help inform guidelines for how to follow up with children with RIS and help accurately inform families of the risk of later developing multiple sclerosis, something we were previously unable to do," Makhani says.