Differential diagnosis of multiple sclerosis and acquired central nervous system demyelinating disorders in children and adolescents

Chapters in this volume describe clinical, pathologic, and diagnostic findings for a spectrum of acquired demyelinating central nervous system (CNS) disorders that occur in children. Progress toward determining triggers for these disorders in order to prevent occurrences and toward optimizing treatment in order to minimize morbidity and mortality are dependent on establishing the correct diagnosis for each child. This would not be difficult if pathologic specimens were always available for clinicopathologic correlation. However, concern regarding potential morbidity from biopsy of a central nervous system lesion makes it rare to have a pathologic specimen available for clinical diagnosis. Indirect measures, including serum and cerebrospinal fluid inflammatory markers, multimodality evoked potentials, and magnetic resonance imaging (MRI), are correlated with history and neurologic examination in order to reach a diagnosis. However, this analysis is not as universally specific as one would like. This chapter will review the spectrum of inflammatory, infectious, metabolic, and neurodegenerative disorders that can overlap or simulate the phenotype of demyelinating disorders in children, including its relapsing–remitting nature. In 2007, a US Network of Pediatric Multiple Sclerosis Centers of Excellence funded by the National Multiple Sclerosis Society reviewed their experience regarding final diagnoses of children referred to the network for evaluation of possible pediatric multiple sclerosis (MS) [1].