Diagnosing pediatric MS: more accurate with test refinements.
Refining tests used to detect multiple sclerosis (MS) in adults yielded more accurate results in diagnosing MS in children.
Neurologists at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania have determined that adding specific modifications to traditional Multiple Sclerosis Functional Composite (MFSC) testing designed to detect outcome measurements in adult patients with MS has proven to be a more sensitive metric for pediatric MS than the standard MFSC or Children's MFSC (ChiMFSC) tests.
The traditional MSFC is designed as a quick clinical test intended as a tool to "capture the most relevant dimensions of function and disability" including motor skills, mobility, and cognition. Amy T. Waldman, MD, and colleagues outline the structure of the MSFC as follows: "The MSFC initially included three components: a timed 25-foot walk [T25FW], 9-hole peg test [9HPT], and the Paced Auditory Serial Addition Task [PASAT]. Modifications to the original MSFC, such as adding binocular low-contrast letter acuity (LCLA) or substituting the symbol digit modalities test (SDMT) for the PASAT, improved the capacity to capture neurologic impairment in adults."
Lacking similar research and data on effectiveness of determining neurologic impairment in pediatric MS, this new study by Waldman and colleagues determined to evaluate the effectiveness of the specific modifications to the traditional MSFC as a means to capture neurologic impairment in patients under the age of 18. Waldman and colleagues noted that a need for increased sensitivity in testing for pediatric MS is necessary because many patients with pediatric MS show significantly fewer outward signs of the neurological disorder than adult patients, particularly in the areas of gait impairment and sustained disability.
Waldman and colleagues note that the goal of these tests is to collect quantifiable data on physical functioning, vision, and cognition impairments which affect patient quality of life. Their focus on relapsing-remitting MS in MSFC testing allows doctors and clinicians to chart the effects of relapse. Waldman writes that "relapsing-remitting MS in both adults and children leads to episodic neurological impairment with variable recovery and poses a risk for progressive disability." Quantifiable data on disability progression would benefit both specific patients and provide raw materials for prevention and therapy studies.
The study conducted by Waldman and colleagues focused on a population of 20 pediatric-onset MS subjects, aged 6 to 21 years, and 13 healthy controls, aged 6 to 19 years.
Subjects with relapsing-remitting MS presenting with a first attack prior to age 18 years were recruited from the Pediatric MS Program at the Children's Hospital of Philadelphia as a convenience sample between 2007 and 2012." The study used a modification of the traditional MSFC including the SDMT and binocular LCLA to test the responses of both the children with MS and the healthy control group.
Results showed that "a modified MSFC 4 with the SDMT replacing the ChiPASAT and including binocular 1.25% LCLA had the greatest capacity to distinguish pediatric MS from controls," and provided a greater sensitivity to "capture the subtle impairments that characterize pediatric MS." Waldman and colleagues propose that the SDMT replace the ChiPASAT "as a brief, screening tool for cognitive impairment, and also note that "the ability of the SDMT to discriminate pediatric MS from healthy youth longitudinally over a short-duration further supports the inclusion of this test in future pediatric treatment trials," although their results should be validated by further study.
The article "Binocular low-contrast letter acuity and the symbol digit modalities test improve the ability of the Multiple Sclerosis Functional Composite to predict disease in pediatric multiple sclerosis" was published in the October 2016 issue of Multiple Sclerosis and Related Disorders.