Brain alterations associated with multiple sclerosis can be revealed by MRI brain scans before the clinical symptoms of the disease appear in children, a new study from Yale suggests.

By the time multiple sclerosis (MS) is typically diagnosed in children, it may be challenging to prevent the disabilities and relapses that come with the disease. Yale School of Medicine researchers examined magnetic resonance imaging (MRI) scans to identify children at high risk of developing MS before symptoms appear, which may lead to earlier diagnosis and treatment.

The 38 children in the study all underwent MRI scans for other reasons, most commonly headache, but the MRIs unexpectedly revealed signs of MS. Having MRI findings of MS without any symptoms of the disease has been termed radiologically isolated syndrome (RIS) and previously had only been seen in adults.

Radiologically Isolated Syndrome

Lead author Naila Makhani, M.D., assistant professor of pediatrics and neurology at Yale School of Medicine, said:

“For the first time we have proposed a definition of RIS in children. Children with RIS may represent a high-risk group of children that needs to be followed more closely for the later development of clinical multiple sclerosis."

Around 42% of children in the study with MRI findings of MS developed the first clinical symptoms of the disease about 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 highest risk of developing the clinical symptoms of multiple sclerosis.

According to Makhani, 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 a sample size to reliably draw conclusions about the effect of treatment, she cautions.

Naila Makhani, Christine Lebrun, Aksel Siva, David Brassat, Clarisse Carra Dallière, Jérôme de Seze, Wei Du, Françoise Durand Dubief, Orhun Kantarci, Megan Langille, Sona Narula, Jean Pelletier, Juan Ignacio Rojas, Eugene D. Shapiro, Robert T. Stone, Mar Tintoré, Ugur Uygunoglu, Patrick Vermersch, Evangeline Wassmer, Darin T. Okuda, Daniel Pelletier Radiologically isolated syndrome in children Neurology - Neuroimmunology Neuroinflammation, 2017; 4 (6): e395 DOI: 10.1212/NXI.0000000000000395

Image: Govind Bhagavatheeshwaran, Daniel Reich, National Institute of Neurological Disorders and Stroke, National Institutes of Health

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