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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).