Criteria used to assess adults for multiple sclerosis may fail to identify the illness in children, a new study shows.

That oversight could delay treatment of the disease at its earliest stages, the researchers say.

Magnetic resonance imaging (MRI) is the primary tool used for diagnosis of MS, and doctors have applied various standards over the years to classify those most likely to develop the disease. The most recent standard, known as the McDonald criteria, was last updated in 2017.

In some cases, imaging suspicious for MS is found incidentally before the disease manifests, a condition known as radiologically isolated syndrome (RIS). But after reviewing the MRIs of children with RIS, the researchers determined these criteria are likely insufficient for pediatric patients.

“In our study, not all patients met the McDonald or Barkhof criteria [the current standard for diagnosing adult RIS], yet some went on to develop MS,” says Vikram Bhise, director of Child Neurology and Developmental Disabilities at Rutgers University Robert Wood Johnson Medical School, and lead author of the study in the journal Multiple Sclerosis and Related Disorders.

“This suggests that the criteria used to characterize RIS in adults might be insufficient for the younger population.”

To determine if children with abnormal MRI findings would develop symptoms associated with MS, and to understand how diagnostic tools used for adults apply to children, researchers examined MR images of children suspected of having demyelination, damage to the protective myelin sheath that surrounds nerve fibers in the brain.

When the myelin sheath is damaged, nerve impulses slow or even stop, causing neurological issues. This damage appears as lesions—white or gray spots—on an MRI. There are many reasons for abnormal MRI findings; most don’t represent demyelination. While not all patients with MRI findings typical of demyelination go on to develop MS, a substantial number do.

Read the full article about multiple sclerosis by Patti Zielinski at Futurity.