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[Childhood multiple sclerosis and allied demyelinative diseases]
Abstract:
We report five cases of multiple sclerosis (MS) and three cases of allied demyelinative diseases starting during childhood. Three of the MS patients presented with atypical initial symptoms, such as acute encephalitis or myelitis, making an early clinical diagnosis difficult. Ophthalmologic symptoms were noted in four of MS children, and in two with allied demyelinative diseases. Therefore, if a child shows ophthalmologic symptoms (i.e. optic neuritis, ophthalmoplegia), brain magnetic resonance imaging (MRI) should be conducted for the differential diagnosis of MS and other demyelinative diseases. Cerebrospinal fluid analysis is not useful for the initial diagnosis of MS, because pleocytosis and increase of oligoclonal IgG band in cerebrospinal fluid are seen in both MS and other demyelinative disorders. However, neuron specific enolase (NSE) is slightly higher in the latter than in the former. T2-weighted MRI of multiple sclerosis showed multiple high intensity areas in the white matter of the cerebrum and cerebellum, capsula interna, and crus cerebri etc. Most of these lesions were clinically silent, being characteristic of MS. In two MS cases, however, initial MRI revealed no abnormal findings. Thus, the diagnosis of MS can not be made by initial MRI only.
Insights
Pediatric multiple sclerosis (MS) and demyelinating diseases can present with atypical symptoms. Early diagnosis requires considering ophthalmologic signs and brain MRI, as cerebrospinal fluid analysis is not definitive for MS.
Area of Science:
- Pediatric Neurology
- Neuroimmunology
- Demyelinating Diseases
Background:
- Childhood-onset multiple sclerosis (MS) and allied demyelinating diseases present diagnostic challenges.
- Atypical initial symptoms, including encephalitis or myelitis, can complicate early clinical diagnosis.
Purpose of the Study:
- To highlight the diagnostic difficulties in pediatric MS and allied demyelinating diseases.
- To emphasize the role of ophthalmologic symptoms and neuroimaging in early diagnosis.
- To compare the utility of cerebrospinal fluid (CSF) analysis and MRI in differentiating these conditions.
Main Methods:
- Case series reporting on five pediatric MS and three allied demyelinating disease cases.
- Clinical symptom analysis, including ophthalmologic manifestations.
- Cerebrospinal fluid (CSF) analysis for pleocytosis and oligoclonal IgG bands.
- T2-weighted brain magnetic resonance imaging (MRI) for lesion detection.
Main Results:
- Ophthalmologic symptoms were present in a significant proportion of children with MS and allied demyelinating diseases.
- CSF analysis showed similar findings (pleocytosis, oligoclonal IgG bands) in both MS and other demyelinating disorders, limiting its diagnostic value for MS.
- Neuron-specific enolase (NSE) levels were slightly higher in allied demyelinating diseases compared to MS.
- T2-weighted MRI revealed characteristic white matter lesions in most MS cases, but initial MRI was normal in two cases, indicating its limitations for definitive early diagnosis.
Conclusions:
- Ophthalmologic symptoms in children warrant consideration for MS and allied demyelinating diseases, necessitating brain MRI for differential diagnosis.
- CSF analysis is not sufficiently discriminative for the initial diagnosis of pediatric MS.
- While MRI is crucial, normal initial findings do not exclude MS, underscoring the need for comprehensive diagnostic evaluation.