Childhood multiple sclerosis: Our experience and a review of the literature

Introduction. Multiple sclerosis (MS) is infrequent in childhood (0.3-2% of all cases of MS). At the present time more and more paediatric patients are being described. In this paper we describe our experience. Material and methods. We review seven patients diagnosed as having MS before the age of 16, between 1984 and 1996. We have recorded: age, sex, personal and family history, form of onset and clinical course, CSF, neurophysiological and neuroimaging tests, treatment and diagnostic category according to the criteria of Poser. Results. Four boys and three girls aged between three and thirteen years at the onset of the disorder. In one case there was a family history of MS. The most frequent form of onset was hemiparesia, followed by oculomotor paralysis and cerebellar disorders, Sir cases followed a recurrent-remittent course and one followed a secondarily progressive course. There were oligoclonal bands (OGB) in the CSF in three cases. Visual evoked potentials (VEP) were abnormal in six cases. Magnetic resonance (RM) was a great help in diagnosis and in six cases was very informative. Six patients were treated with corticosteroids during the acute phase and two with long-term azathioprine. Conclusions. The commonest form of presentation, hemiparesia, makes the differential diagnosis with acute hemiplegia of childhood obligatory. Neurophysiological techniques, especially the VEP are very useful for initial assessment. RM is the most sensitive method although it is,lot specific for diagnosis. The average follow-up period (4.5 years) is too short to determine the prognosis [REV NEUROL 1998; 27: 237-41].