Multiple Sclerosis in Children: Report of Clinical and Paraclinical Features of 19 Cases

Abstract

We report our experience concerning clinical and paraclinical features of multiple sclerosis in 19 children. The disease was highly variable in its presentation but acute episodes of retrobulbar optic neuritis or transverse myelitis or cerebellitis were commonly observed at the onset. Diagnosis was very often suspected as soon as the first episode when there was clinical evidence of more than one lesion (43%) or study of the cerebrospinal fluid demonstrated a local secretion of immunoglobulins (60%). Evoked potential studies and nuclear magnetic resonance imaging were performed during the course of the disease and exhibited abnormalities of the kind observed in adult patients and with a similar frequency; this suggests that such studies can be very useful in the evaluation of children suspected of having multiple sclerosis. When the initial form of the disease was a chronic myelopathy, the course was progressive from the onset, leading rapidly to a marked invalidity (15%). Most often a succession of relapses and remissions occurred after the first attack and major sequelae appeared 5 to 10 years later. Such features are not very different from those observed in adult patients and suggest that these patients can benefit from the progress resulting from therapeutic trials in adult patients.

Multiple sclerosis vs acute disseminated encephalomyelitis in childhood

“…This trend is similar to that evident in three acute disseminated encephalomyelitis and 12 multiple sclerosis patients who were tested: no acute disseminated encephalomyelitis and eight multiple sclerosis patients manifested cerebrospinal fluid positive for oligoclonal bands. The MRI in acute disseminated encephalomyelitis and multiple sclerosis may look similar in terms of diffuse T 2 -weighted hyperintensities, but the location of lesions in multiple sclerosis compared with those in acute disseminated encephalomyelitis may help differentiate these two entities [2,7,[13][14][15]. The location of T 2 -weighted hyperintensities in the present multiple sclerosis patients supports what has been described, given the preferential periventricular (91% vs 50%) and corpus callosum (64% vs 17%) involvement with a greater tendency to spare the cortical gray matter (9% vs 33%) and thalami (18% vs 33%) when compared with acute disseminated encephalomyelitis.…”

Characteristics of Children and Adolescents With Multiple Sclerosis

“…[1][2][3][4][5][6][7][8] Initial descriptions of childhood-onset MS appeared in case reports and small case series. [9][10][11][12] Greater awareness and interest led to increased publications, including larger case series, reports from single institutions, multicenter studies, and national and population-based surveys. [1][2][3][4][5][6][7][8][13][14][15][16][17] Pediatric-onset MS (pediatric MS) was compared with adult-onset MS in a few publications.…”

Exacerbation of Chronic Inflammatory Demyelinating Polyradiculoneuropathy during Interferon.BETA.-1b Therapy in a Patient with Childhood-onset Multiple Sclerosis

“…Childhood MS reportedly has some distinct clinical and immunological features compared with adult-onset MS, such as a lower frequency of oligoclonal IgG bands in CSF (21), higher CSF cell counts (22), a higher frequency of EEG abnormalities (21), and a higher frequency of relapsing-remitting type (21,23). Moreover, fever, asthenia, and anorexia are frequently present during the first episode in childhood MS in association with symptoms related to involvement of the spinal cord or cerebellum, suggesting an acute postinfectious autoimmune disorder (22). Such immunological characteristics might also be related to the predisposition for CIDP after IFN therapy in childhood-onset MS.…”