Managing pediatric-onset multiple sclerosis in an austere setting: A case report.

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.