Incidence of acquired CNS demyelinating syndromes in a multiethnic cohort of children

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Abstract
Objective: To determine whether the incidence and clinical features of pediatric multiple sclerosis (MS) and other forms of pediatric acquired demyelinating syndromes (ADS) vary by race/ethnicity in a population-based cohort. Methods: We used a combination of electronic database searches followed by complete medical records review to identify all children diagnosed with MS and ADS in the multiethnic membership of Kaiser Permanente Southern California from January 1, 2004, to December 31, 2009. Incidence rates were standardized to the US census by age and gender. Results: We identified 81 incident cases of ADS from 4.87 million person-years of observation in children 0–18 years of age. The incidence rate of pediatric MS was 0.51 per 100,000 person-years (95% confidence interval [CI] 0.33–0.75) and incidence of other forms of ADS including optic neuritis, transverse myelitis, other forms of clinically isolated syndrome (CIS), and acute disseminated encephalomyelitis (ADEM) was 1.56 (95% CI 1.23–1.95) for an overall incidence of ADS of 1.66 per 100,000 person-years (95% CI 1.32–2.06). Incidence of ADS was higher in black (4.4 per 100,000 person-years, 95% CI 2.5–7.2, p < 0.001) and Asian/Pacific Islander (2.8, 95% CI 1.2–5.2, p = 0.02) than white (1.03, 95% CI 0.6–1.7) and Hispanic (1.5, 95% CI 1.1–2.1, per 100,000 person-years) children. Black children were also significantly more likely to have MS than white children (p = 0.001). Children who presented with ADEM were significantly younger than children with other types of ADS clinical presentations (mean age 5.6, range 0.7–17.6 years vs 14.6, range 2.7–18.5, respectively). Conclusions: The incidence of pediatric acquired demyelinating syndromes is 1.66 per 100,000 person-years in a population-based cohort of Southern Californian children. The incidence of ADS and MS is higher in black children compared with white and Hispanic children.