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Table 2 Diagnostic criteria for pediatric MS [31]

From: Pediatric multiple sclerosis: a review

For the diagnosis pediatric CIS, all of the following is required:

− A monofocal or polyfocal, clinical CNS event with presumed inflammatory demyelinating cause.

− Absence of a prior clinical history of CNS demyelinating disease (e.g. absence of past optic neuritis (ON), transverse myelitis (TM) and hemispheric or brain-stem related syndromes).

− No encephalopathy (i.e. no alteration in consciousness or behavior) that cannot be explained by fever.

− The diagnosis of MS based on baseline MRI features (as recently defined) are not met.

For pediatric ADEM, all of the following is required:

− A first polyfocal, clinical CNS event with presumed inflammatory demyelinating cause.

− Encephalopathy that cannot be explained by fever.

− No new clinical and MRI findings emerge 3 months or more after the onset.

− Brain MRI is abnormal during the acute (three-month) phase.

− Typically on a brain MRI:

• diffuse, poorly demarcated, large (> 1–2 cm) lesions involving predominantly cerebral white matter;

• deep grey matter lesions (e.g. thalamus or basal ganglia) may be present;

• T1-hypointense lesions in the white matter are rare.

For pediatric NMO, all of the following are required

− Optic neuritis.

− Acute myelitis.

− At least two of three supportive criteria:

* contiguous spinal cord MRI lesion extending over three vertebral segments;

* brain MRI not meeting diagnostic criteria for MS;

* aquaporin IgG seropositive status.

For pediatric MS, one of the following is required

− ≥ 2 non-encephalopathic, clinical CNS events with presumed inflammatory cause, separated

− by > 30 days and involving more than one CNS area.

− One non-encephalopathic episode typical of MS which is associated with MRI findings consistent with 2010 Revised McDonald criteria for dissemination in space (DIS) and in which a follow-up MRI shows at least one new enhancing or non-enhancing lesion consistent with dissemination in time (DIT) MS criteria.

− One ADEM attack followed by a non-encephalopathic clinical event, three or more months after symptom onset, that is associated with new MRI lesions that fulfill 2010 Revised McDonald DIS criteria.

− A first, single, acute event (e.g. a CIS) that does not meet ADEM criteria and whose MRI findings are consistent with the 2010 revised McDonald Criteria for DIS and DIT (applied only to children ≥12 years old).