Objective: To identify the clinical, biochemical, and radiological profile and factors associated with relapse in pediatric patients with central nervous system (CNS) demyelination. Methods: We reviewed the medical records of 103 patients below 18 years of age with CNS demyelination, evaluated in our center over a period of 12 years, from January 2000 to December 2011. Their clinical picture, laboratory parameters and imaging were studied and compared among those with monophasic and relapsing courses. Results: Mean age was 11.7±5.15 years with 41(39.8%) males. 67(65.0%) had monophasic course and 36 (35.0%) had relapsing illness. Relapsing illness was seen in 29 patients ≥10 years versus 7 patients <10 years (p=0.018). 20.5% with antecedents had a relapse and 45.76% without antecedents had a relapsing illness (p=0.012). Relapsing course was seen in 14(63.6%) patients with optic neuritis and 13(61.9%) with brainstem demyelination as the initial event compared to 4(10.3%) and 5(25.0%) with cerebral demyelination and myelitis respectively. CSF oligoclonal band (OCB) positivity (28.6 % vs 1.5 %, p < 0.001) was more commonly associated with a relapsing course. Initial MRI lesion size more than 2 cm was noted in 15(22.4%) patients with monophasic illness compared to 2 (5.6%) with relapsing illness (p=0.003). Conclusions: ADEM and MS were the commonest demyelinating disorders in our paediatric cohort. Older age, absence of antecedents, initial demyelinating event involving optic nerve or brainstem, CSF OCB positivity and a smaller lesion size on imaging were associated with a relapsing course of CNS demyelination in children.

CNS demyelination, pediatric demyelination, relapse, Multiple sclerosis, ADEM, Neuromyelitis Optica spectrum disorder