Clinical Manifestations of Childhood Multiple Sclerosis

Abstract

Neurology| March 01 2007 Clinical Manifestations of Childhood Multiple Sclerosis AAP Grand Rounds (2007) 17 (3): 30–31. https://doi.org/10.1542/gr.17-3-30 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Clinical Manifestations of Childhood Multiple Sclerosis. AAP Grand Rounds March 2007; 17 (3): 30–31. https://doi.org/10.1542/gr.17-3-30 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: multiple sclerosis Source: Weng W-C, Yang C-C, Yu T-W, et al. Multiple sclerosis with childhood onset: report of 21 cases in Taiwan. Pediatr Neurol. 2006;35:327–334; doi:10.1016/j.pediatrneurol.2006. 05.002 The records of 21 patients with multiple sclerosis (MS) with onset of symptoms at <18 years of age were analyzed by investigators at the National Taiwan University Hospital, Taipei, and Min-Sheng General Hospital, Taoyuan, Taiwan. Fifteen patients were female and 6 male, with a mean age of 12.4 +/− 4.5 years at presentation. Presenting symptoms or signs, in order of frequency, were: limb weakness (62%); visual loss or field defect (43%); bulbar symptoms such as dysphagia or dysarthria (33%); sensory disturbance (29%); headache (29%); ataxia (19%); bowel or sphincter dysfunction (14%); and encephalopathy or encephalitis (14%). Multiple symptoms occurred at onset in 76% of patients. A viral prodrome, usually upper respiratory, was reported 2 weeks before onset of MS symptoms in 43%. MRIs obtained on patients at the onset of their illness showed lesions in the cerebral white matter in 72%. Lesions were found in periventricular white matter in 56%, in basal ganglia (33%), cerebellum (28%), spinal cord (28%), corpus callosum (22%), and optic nerve (17%). Visual evoked potentials were abnormal in 77% of patients, and 62% had optic nerve involvement. Only 1 patient had optico-spinal MS. Of 9 patients receiving periodic, subcutaneous interferon beta-1a, 4 (44%) had no relapses. The course was relapsing/remitting in 86% and progressive in 14%. The mean interval between the first and second attack was 7.2 +/− 10 months, most occurring within 12 months of each other. Three patients who were initially diagnosed with acute disseminated encephalomyelitis developed MS after 4-month, 2-year, and 6-year intervals, respectively. Dr. Millichap has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of a commercial product/device. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. In the classic reports of MS in US children published in Pediatrics in the 1950s, the symptoms, in order of decreasing frequency, were ataxia or limb weakness, visual disturbance, numbness, headache and vomiting, and urinary incontinence.1,2 The symptoms were similar to those listed in the current report of MS in Taiwanese children. Although the etiology of MS is unknown, a viral infection early in life, subject to periodic activation, is a hypothesis that is supported by the occurrence of oligoclonal bands in the CSF of MS patients3 and a viral prodrome reported 2 weeks before the onset of symptoms in 43% of the patients in this study. Other factors, including genetics, race, gender, environmental factors, and an autoimmune process may also play a role in the etiology. The concordance rate for MS among monozygotic twins is 26% compared to 2% for dizygotic twins.4 In some Asian countries the rate of MS is relatively low compared to that of Western countries. However, the results of 1 study indicated that 3.5% of patients in China had onset before age... You do not currently have access to this content.