How well can MRI predict MS in children with acute disseminated encephalomyelitis?

First time demyelination in children is seen in approximately 0.9/100,000 of the population.1 In childhood, initial demyelinating events may take on different forms, such as acute disseminated encephalomyelitis (ADEM) or clinically isolated syndromes (CIS), each of which may carry a different prognosis. For example, although 45% of all children with an initial demyelinating episode will have a second episode,2 only 20% of children who are initially diagnosed with ADEM will later receive the diagnosis of multiple sclerosis (MS).3 The question of how to predict which children, after a single demyelinating episode, will go on to experience recurrent episodes is an important clinical one, as diagnosis of MS will lead to the introduction of disease-modifying therapies. In the adult population, MRI can predict the conversion of CIS to MS. However, knowledge about MRI in adult MS does not always apply to the pediatric population. For example, a cross-sectional study has shown that adult-based MS criteria specifying lesional distribution have low sensitivity and specificity in children (≥3 of ≥9 …