What is the role of lab tests in the workup of pediatric multiple sclerosis (MS)?

Updated: Jan 30, 2019
  • Author: Alice K Rutatangwa, DO, MSc; Chief Editor: Amy Kao, MD  more...
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Answer

The CSF profile in childhood-onset multiple sclerosis (MS) may vary by age. Typically, WBC counts range from 0-50 cells/mm3, with a lymphocytic predominance. [38] However, it has been shown that children younger than 11 years have more neutrophils in the CSF than older children. [39]

While one study reports OCB in the CSF of up to 92% of children with MS, [40] another study found OCB to be less common in younger children (43% vs 63% in adolescents). [39] By contrast, in ADEM, 0%–29% of cases are found to have OCB. [38, 30, 41, 31] Within the French KIDMUS cohort, 94% (69 of 72) of children with positive OCB results went on to develop MS. [42]

The IgG index has been found to be elevated in 68% of adolescents (>11 years) with MS but in 35% of younger children (< 11 years). [39] These features tend to depend on age rather than disease duration. This distinct CSF IgG and cellular profile in younger children tends to vanish on repeat CSF analysis (mean 19 months after initial analysis), suggesting a transient immunological phenomenon associated with disease onset.


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