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Incidence of acquired demyelination of the CNS in Canadian children

AUTHORS’ AFFILIATIONS From The Hospital for Sick Children (B.B., J.K., S.M.), Toronto, Ontario; University of British Columbia (C.G., D.S.), Vancouver, British Columbia; Vancouver Coastal Health Authority (C.G., D.S.), UBC Hospital, British Columbia; Montreal Neurological Institute (D.L.A., A.B.-O.), Quebec; McGill University (D.L.A., A.B.-O.), Montreal, Quebec; Victoria General Hospital (K.W.), British Columbia; Children’s Hospital of British Columbia (M.B.C.), Vancouver, British Columbia; Stollery Children’s Hospital (J.Y.), Edmonton, Alberta; Alberta Children’s Hospital (J.K.M.), Calgary, Alberta; The Children’s Hospital of Winnipeg (N.S.), Manitoba; Centre Hospitalier Universitaire de Sherbrooke (G.S.), Quebec; McMaster Children’s Hospital (B.M.), Hamilton, Ontario; The Montreal Children’s Hospital (M.-E.D.), Quebec; Centre Hospitalier Universitaire de Sainte-Justine (A.L.), Montreal, Quebec; Children’s Hospital of Eastern Ontario (S.W., A.D.), Ottawa, Ontario; Children’s Hospital of Western Ontario (S.L.), London, Ontario; Queen’s University (E.A.M.), Kingston, Ontario; Saint John Regional Hospital (D.M.), New Brunswick; IWK Health Centre (E.W.), Halifax, Nova Scotia; Royal University Hospital (N.L.), Saskatoon, Saskatchewan; Janeway Children’s Health and Rehabilitation Centre (D.B.), St. John’s, Newfoundland; Trillium Health Centre (C.Y.), Mississauga, Ontario; Windsor Regional Hospital (M.A.), Ontario; Rouge Valley–Centenary Hospital (P.C.), Scarborough, Ontario; Hôpital Charles LeMoyne (F.G.), Montreal, Quebec; Sudbury Regional Hospital (J.B.B.), Ontario; and Dalhousie MS Research Unit (V.B.), Halifax, Nova Scotia, Canada.

Address correspondence and reprint requests to Dr. Brenda Banwell, Research Institute, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, M5G 1X8 Canada brenda.banwell{at}sickkids.ca

Background: The incidence of acquired demyelination of the CNS (acquired demyelinating syndromes [ADS]) in children is unknown. It is important that physicians recognize the features of ADS to facilitate care and to appreciate the future risk of multiple sclerosis (MS).

Objective: To determine the incidence, clinical features, familial autoimmune history, and acute management of Canadian children with ADS.

Methods: Incidence and case-specific data were obtained through the Canadian Pediatric Surveillance Program from April 1, 2004, to March 31, 2007. Before study initiation, a survey was sent to all pediatric health care providers to determine awareness of MS as a potential outcome of ADS in children.

Results: Two hundred nineteen children with ADS (mean age 10.5 years, range 0.66–18.0 years; female to male ratio 1.09:1) were reported. The most common presentations were optic neuritis (ON; n = 51, 23%), acute disseminated encephalomyelitis (ADEM; n = 49, 22%), and transverse myelitis (TM; n = 48, 22%). Children with ADEM were more likely to be younger than 10 years, whereas children with monolesional ADS (ON, TM, other) were more likely to be older than 10 years (p < 0.001). There were 73 incident cases per year, leading to an annual incidence of 0.9 per 100,000 Canadian children. A family history of MS was reported in 8%. Before study initiation, 65% of physicians indicated that they considered MS as a possible outcome of ADS in children. This increased to 74% in year 1, 81% in year 2, and 87% in year 3.

Conclusion: The incidence of pediatric acquired demyelinating syndromes (ADS) is 0.9 per 100,000 Canadian children. ADS presentations are influenced by age.

Abbreviations: ADEM = acute disseminated encephalomyelitis; ADS = acquired demyelinating syndromes; CI = confidence interval; CPSP = Canadian Pediatric Surveillance Program; mono-ADS = monolesional presentation; MS = multiple sclerosis; ON = optic neuritis; OR = odds ratio; poly-ADS = polylesional presentation; TM = transverse myelitis.

Authors’ affiliations are listed at the end of the article.

This study was funded by the Multiple Sclerosis Society of Canada and the Multiple Sclerosis Scientific Research Foundation and was performed in conjunction with the Canadian Paediatric Society Surveillance Program.

Disclosure: The authors report no disclosures.

Received May 12, 2008. Accepted in final form October 13, 2008.

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