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Pediatric multiple sclerosis (MS) is clearly underrecognized and is often misdiagnosed as acute disseminated encephalomyelitis (ADEM), or as one of many relapsing pediatric neurologic conditions. Up to 5% of MS cases have a pediatric onset,1 and there are an estimated 10,000 cases in the United States alone.2 Recently, the International Pediatric MS Study Group proposed new clinical criteria for pediatric MS and related demyelinating disorders.3 However, definitive MRI criteria for these conditions are lacking. Recent studies have shown that at the time of their MS-defining attack, children meet McDonald MRI criteria only 67% of the time, suggesting a lower lesion burden at the time of presentation compared to adults.4 Previously published studies have suggested that the presence of periventricular and corpus callosum well-defined lesions may be sensitive predictors of MS after a first attack in childhood.5 Thus, neuroimaging biomarkers are powerful tools that may assist in both diagnosis and prognostication for demyelinating disorders in children.
In a pair of articles published in this issue of Neurology®, Callen and a well-recognized team of authors6,7 contrasted the MRI features of clinically definite MS in children with ADEM and with other neurologic diseases. In the first …
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