What is the stepped approach to evaluation of white matter changes 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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Tier 1 consists of the following:

  • CSF: OCB, IgG index, cell count, protein, glucose, HSV, lyme

  • Serum: Complete blood cell (CBC) count, erythrocyte sedimentation rate (ESR), C-reactive protein, NMO antibodies (in cases of optic neuritis and/or longitudinally extensive transverse myelitis), antinuclear panel (including SSA, SSB), thyroid-stimulating hormone, vitamin B12

  • Imaging: Brain and cervical spine MRI with/without gadolinium

  • Other: Ophthalmology (if optic neuritis)

Tier 2 consists of the following:

  • CSF: EBV, cytology, bacterial, fungal, viral cultures

  • Serum: Angiotensin-converting enzyme, HIV, rapid plasma reagin/fluorescent treponemal antibody absorption

  • Imaging: Repeat brain MRI, entire spinal cord with/without gadolinium; chest radiography (sarcoid)

Tier 3 consists of the following:

  • CSF: Human T-lymphotropic virus 1, measles antibodies (subacute sclerosing panencephalitis), lactate, pyruvate

  • Serum: Serum amino acids, mitochondrial panel, WBC enzymes, very long chain fatty acids, acylcarnitine profile, lysosomal enzymes

  • Imaging: Magnetic resonance spectroscopy, magnetic resonance angiography

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