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Onset of multiple sclerosis in a 24-month-old child
Insights
Pediatric multiple sclerosis (MS) is rare, with this case presenting at 24 months. Early-onset MS symptoms like gait ataxia and blindness can remit with steroids, but may recur.
Area of Science:
- Neurology
- Pediatric Neurology
- Neuroimmunology
Background:
- Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system.
- While typically diagnosed in young adults, rare cases of early-onset pediatric MS exist.
- Understanding MS in very young children is crucial for early diagnosis and management.
Observation:
- A 24-month-old child experienced ataxic gait, followed by recurrent gait issues and bilateral blindness.
- Symptoms initially resolved with steroid therapy, but a permanent visual deficit persisted.
- At over 16 years old, the patient experienced a second episode of blindness and grand mal seizures.
Findings:
- Elevated myelin basic protein levels and abnormal visual evoked responses supported neurological dysfunction.
- The combination of cerebellar, cortical, and ocular symptoms, with remissions, led to a diagnosis of multiple sclerosis (MS).
- This represents the youngest documented patient diagnosed with MS, with onset at 24 months.
Implications:
- This case highlights the possibility of extremely early-onset MS, challenging typical age-of-onset parameters.
- Early diagnosis and intervention in pediatric MS are critical for managing disease progression and long-term outcomes.
- Further research into the specific triggers and pathogenesis of infantile-onset MS is warranted.
Abstract:
A child, aged 24 months, incurred an episode of ataxic gait. Two months later, she had a recurrent episode of ataxic gait and bilateral blindness. Her symptoms were resolved with steroid therapy. A permanent visual deficit of 20/200 remained in the right eye. When she reached 16 years 10 months of age, she incurred the second episode of bilateral blindness. One month later, she had grand mal seizures. Her myelin basic protein level was elevated. Visual evoked responses were abnormal bilaterally. The combination of cerebellar, cortical, and eye symptoms, with a history of well-defined remissions, allowed the diagnosis of multiple sclerosis (MS) to be made. This is the youngest known patient with MS yet described, with the first attack occurring at 24 months of age.