A Multicentre Study of Radiologically Isolated Syndrome In Children: Can We Predict The Course?

Objectives: To evaluate demographic, clinical and radiological characteristics of Radiologically Isolated Syndrome (RIS) in children and to describe laboratory and imaging features associated with subsequent clinical event or radiologic evolution.

Methods: Demographic, clinical and radiological characteristics of children with MRI findings fulfilling the revised 2017 McDonald Criteria for dissemination in space but without symptoms of demyelinating disease were retrospectively analyzed.

Results: There were total 69 patients (38 girls,31 boys). The median age at index MRI was 16.6 years, and median follow-up, 21 months (1-96 months). The most common reason for neuroimaging was headache (55%). A first clinical event occurred in 14/69 (20.3%) children in median 11 (1-35) months, in 14/69 (20.3%) of patients meeting Mc Donald 2017 criteria and 6/28 (21.4%) of those meeting Barkhof criteria. New lesions on imaging developed in 34/54 (62.96%) children in median 6 (1-18) months. Oligoclonal bands (OCB) in cerebrospinal fluid (CSF) were associated with an increased risk of clinical (p<0.05) and radiologic (p=0.022) evolution.

Conclusion: CSF OCB positivity was the only predictor of subsequent clinical or radiologic evolution. Children with CSF OCB positivity should be closely followed-up for conversion to MS although the optimal disease modifying treatment (DMT) for such cases is unknown. Longitudinal follow-up and controlled treatment trials are needed to define the preventive role of DMT in high-risk children and the real risk of conversion to MS.