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638 A six-year-old girl presents with acute visual loss (optic neuritis). Her magnetic resonance imaging scan shows multiple white matter lesions, consistent with demyelination. Will she recover completely? Will she continue to experience recurrent episodes of demyelination and, thus, meet the criteria for the chronic autoimmune disease, multiple sclerosis (MS)? The incidence of acute demyelination of the central nervous system in Canadian children is unknown. While not all children initially affected will go on to experience recurrent attacks characteristic of MS, their future remains uncertain. The risk of subsequent MS and the clinical, biological and neuroimaging predictors of MS risk have yet to be defined. Parents and health care professionals often do not consider MS a possible diagnosis based on an initial demyelinating event. The advent of disease-modifying therapies for MS and the recent evidence of improved long-term outcome associated with early therapy initiation emphasize the need for prompt diagnosis and coordinated care for children affected with MS. Are acquired demyelinating syndromes of the central nervous system underdiagnosed in Canadian children? CPSP HIGHLIGHTS