A framework for measurement and harmonization of pediatric multiple sclerosis etiologic research studies: The Pediatric MS Tool-Kit

Mult Scler. 2019 Jul;25(8):1170-1177. doi: 10.1177/1352458518783345. Epub 2018 Jun 22.


Background: While studying the etiology of multiple sclerosis (MS) in children has several methodological advantages over studying etiology in adults, studies are limited by small sample sizes.

Objective: Using a rigorous methodological process, we developed the Pediatric MS Tool-Kit, a measurement framework that includes a minimal set of core variables to assess etiological risk factors.

Methods: We solicited input from the International Pediatric MS Study Group to select three risk factors: environmental tobacco smoke (ETS) exposure, sun exposure, and vitamin D intake. To develop the Tool-Kit, we used a Delphi study involving a working group of epidemiologists, neurologists, and content experts from North America and Europe.

Results: The Tool-Kit includes six core variables to measure ETS, six to measure sun exposure, and six to measure vitamin D intake. The Tool-Kit can be accessed online ( www.maelstrom-research.org/mica/network/tool-kit ).

Conclusion: The goals of the Tool-Kit are to enhance exposure measurement in newly designed pediatric MS studies and comparability of results across studies, and in the longer term to facilitate harmonization of studies, a methodological approach that can be used to circumvent issues of small sample sizes. We believe the Tool-Kit will prove to be a valuable resource to guide pediatric MS researchers in developing study-specific questionnaire.

Keywords: Multiple sclerosis; etiology; pediatrics; questionnaires; risk factors; sunlight; tobacco smoke pollution; vitamin D.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child
  • Data Collection / standards*
  • Delphi Technique
  • Europe
  • Guidelines as Topic / standards*
  • Humans
  • Multiple Sclerosis / etiology*
  • Risk Factors*
  • Sunlight*
  • Tobacco Smoke Pollution*
  • Vitamin D*


  • Tobacco Smoke Pollution
  • Vitamin D