Investigators at Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children’s Hospital of Chicago review the diagnostic criteria for pediatric multiple sclerosis, the differential diagnosis, the 2010 McDonald criteria, and Callen criteria. Of all persons with MS, 2% to 5% have onset before 16 years of age. The diagnosis is clinical, requiring recurrent episodes of CNS demyelination, serial changes in MRI lesions, and CSF oligoclonal bands or elevated IgG index. MS must be differentiated from ADEM, neuromyelitis optica and other inflammatory, infectious or metabolic conditions. These include mitochondrial disorders, leukodystrophy, Alexander’s disease, MELAS, Kearn-Sayre syndrome, Behcet and Sjogren syndromes, sarcoidosis, Hashimoto’s encephalitis, HIV, herpes virus, neuroborreliosis, mycoplasma, the arteriopathy CADASIL, and CNS vasculitis. [1]

COMMENT. In this excellent and comprehensive review, the differentiation of MS from ADEM and other inflammatory or infectious conditions is stressed. Transient demyelinating events must be distinguished from a life-long diagnosis of MS.

Cerebral venous thrombosis (CVT) after LP and steroids in childhood MS. The association between CVT and MS is reported in a 13-year-old girl admitted with left hemiparesis, ataxia, and headache following vaccination against meningococcal group C and hepatitis A. LP and high dose corticosteroids for MS may have contributed to the CVT. [2]