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Managing pediatric-onset multiple sclerosis in an austere setting: A case report
Josephine U Pierce Pucci1, Heather M Soloria2, Philip G Eye1
1Department of Pediatrics, Tripler Army Medical Center, Honolulu, HI, USA.
Insights
Pediatric-onset multiple sclerosis (POMS) management in resource-limited areas presents challenges. This case study highlights successful POMS flare treatment using telemedicine and multidisciplinary care.
Area of Science:
- Neurology
- Pediatrics
- Public Health
Background:
- Pediatric-onset multiple sclerosis (POMS) is a significant demyelinating disease in children, causing physical, cognitive, and psychosocial issues.
- Effective management of POMS necessitates a coordinated multidisciplinary care approach.
Purpose of the Study:
- To present a case study of managing POMS in a child who relocated to a resource-limited setting (Guam).
- To illustrate the successful application of telemedicine in diagnosing and treating a POMS flare without immediate local specialist access.
Main Methods:
- A case report of an 11-year-old boy with POMS experiencing a flare in Guam.
- Utilized a combination of local pediatric, ophthalmology, and emergency medicine, with real-time and asynchronous remote guidance from child neurology and cardiology specialists.
- Implemented steroid treatment for the acute flare and initiated Fingolimod for disease modification.
Main Results:
- The POMS flare was accurately diagnosed and effectively treated with corticosteroids.
- The patient was successfully initiated on Fingolimod, a disease-modifying therapy.
- An emergency management plan was established for future POMS exacerbations.
Conclusions:
- Telemedicine, combining synchronous and asynchronous modalities, is crucial for managing pediatric multiple sclerosis in underserved or remote locations.
- Multidisciplinary collaboration, even remotely, is key to achieving satisfactory treatment outcomes for POMS.
- This case demonstrates effective strategies for acute and chronic POMS care in resource-limited environments.
Abstract:
Pediatric-onset multiple sclerosis (POMS) is the most common demyelinating disease in children. Patients suffer from physical disability, cognitive impairment, and psychosocial challenges. Management requires a multidisciplinary care team. Here we present a case of an 11-year-old boy with POMS who relocated to Guam prior to initiation of a disease-modifying treatment and who experienced a flare without immediate access to an MRI or a child neurologist. Care required the combined efforts of ophthalmology, pediatrics, and emergency medicine in Guam, real-time remote guidance by child neurology, and asynchronous collaboration with cardiology and child neurology. As a result, the immediate flare was accurately diagnosed and treated with steroids, the patient was started on Fingolimod, and an emergency management plan for future flares was constructed. This case illustrates the nuances of both the acute and chronic management of multiple sclerosis in a resource-limited setting and how a combination of synchronous and asynchronous telemedicine was able to achieve a satisfactory treatment plan.
