Mikaeloff et al identified prognostic factors for a child with multiple sclerosis. The authors are from the Kid Sclerose en Plaques Study Group (KIDSEP) in France and Canada.
Patient selection: multiple sclerosis with onset before age 16 years
Criteria for severe disease:
(1) occurrence of A3 (a third attack) or
(2) severe disability, with disability status scale (DSS) >= 4
Parameters:
(1) gender
(2) time between first (A1) and second attack (A2)
(3) childhood-onset multiple sclerosis MRI criteria at onset (presence of lesions perpendicular to the long axis of the corpus callosum and/or presence of well-defined lesions)
(4) severe mental status changes at onset
(5) course
Parameter |
Finding |
Points |
gender |
male |
1 |
|
female |
1.45 |
time between first and second attacks |
< 12 months (< 1 year) |
1.56 |
|
>= 12 months (>= 1 year) |
1 |
MRI criteria at onset |
absent |
1 |
|
present |
1.89 |
severe mental status changes at onset |
absent |
1.91 |
|
present |
1 |
course |
progressive |
2.93 |
|
not progressive |
1 |
potential index =
= PRODUCT(points for all 5 parameters)
Interpretation:
• minimum index: 1 (no risk factors present)
• maximum index: 23.9 (all 5 risk factors present)
• The higher the index the greater the risk for early severity.
Quartile |
Median Value |
Probability of Not Having Severe Disease at 3 Years After Onset |
1 |
1.9 |
53% |
2 |
4.3 |
42% |
3 |
5.6 |
25% |
4 |
8.2 |
7% |
from Figure 1, page 1137
Specialty: Neurology, Immunology/Rheumatology
ICD-10: ,