Multiple sclerosis in children – clinical aspects and diagnostic dilemmas

Authors

  • Ewa Jamroz Klinika Pediatrii i Neurologii Wieku Rozwojowego, Śląski Uniwersytet Medyczny, Katowice
  • Justyna Paprocka Klinika Pediatrii i Neurologii Wieku Rozwojowego, Śląski Uniwersytet Medyczny, Katowice
  • Jerzy Pietruszewski Klinika Pediatrii i Neurologii Wieku Rozwojowego, Śląski Uniwersytet Medyczny, Katowice
  • Anna Bojda Studenckie Towarzystwo Naukowe przy Klinice Pediatrii i Neurologii Wieku Rozwojowego Śląskiego Uniwersytetu Medycznego, Katowice
  • Alicja Betkiewicz Studenckie Towarzystwo Naukowe przy Klinice Pediatrii i Neurologii Wieku Rozwojowego Śląskiego Uniwersytetu Medycznego, Katowice

Keywords:

multiple sclerosis, children, diagnostics

Abstract

Background. Multiple sclerosis (MS) is a chronic, acquired demyelinating disease affecting central nervous system. The pathogenesis of the disorder is still unclear, although experimental models provide evidences of autoimmune and inflammatory basis of the disease. The estimated occurence of MS is 3.6 cases per 100,000 person-years in women and 2.0 in men. Up to 10% of patients experiences their first symptoms before the age of 18.The diagnosis of MS in adults is based on Mc Donald criteria, that include clinical symptoms, magnetic resonance imaging (MRI) of the brain and spinal cord, the presence of oligoclonal bands in cerebrospinal fluid (CSF) and abnormal visual evoked potentials. These criteria are less useful in early stages of the disease in children. The exact diagnosis in young patients is even more difficult because of clinical presentation which may suggest other inflammatory-demyelinating and neurometabolic diseases.

Aim. The authors analyze a group of 29 children (clinical presentation and additional examinations) in reference to current diagnostic criteria. 

Material and methods. The analyzed group consisted of 27 children hospitalized in Child Neurology Department of Medical University of Silesia in Katowice in the years 2005- 2010. The average age at diagnosis was 15 years, the range was 5 to 17 years.

Results. All children exhibited relapsing, remitting multiple sclerosis. In the analyzed group, patients presented with initial symptoms concerning predominantly sensory and motor symptoms - 52 %. The oligoclonal bands were present in 91% of examined children. 58% of patients fulfill the 2005 McDonald criteria, revised 2010 McDonald criteria 90%. 17 children presented three out of four Barkhof magnetic resonance imaging criteria.

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References

Krupp L, Banwell B, Tenembaum S, for the International Pediatric MS Study Group. Consensus definitions proposed for pediatric multiple sclerosis. Neurology 2007;68: S7–S12.

Banwell B, Ghezzi A, Bar-Or A, Mikaeloff Y, Tardieu M. Multiple sclerosis in children: clinical diagnosis, therapeutic strategies, and future directions. Lancet Neurol 2007;6: 887–902.

Alonso A, Hernan M. Temporal trends in the incidence of multiple sclerosis: a systematic review. Neurology 2008; 71: 129–135.

Vargas-Lowy D, Chitnis T. Pathogenesis of pediatric multiple sclerosis. J Child Neurol 2012;27:1394-1407.

Bigi S, Banwell B. Pediatric Multiple Sclerosis. J Child Neurol 2012;27:1378-1383.

Armato MP, Goretti B, Ghezzi A et al. Cognitive and psychosocial features in childhood and juvenile MS: two-year follow-up. Neurology 2010;75:1134-1140.

Tumani H, Hartung HP, Hemmer B et al. The BioMS Study Group. Cerebrospinal fluid biomarkers in multiple sclerosis. Neurobiol Dis 2009;35:117-127.

Huppke P, Gartner J. A practical guide to pediatric multiple sclerosis. Neuropediatrics 2010;41;157-162.

Mesaros S, Rocca MA, Absinta M et al. Evidence of thalamic grey matter loss in paediatric multiple sclerosis. Neurology 2008;70:1107–12.

Ness J, Chabas D, Sadovnick A, Pohl D, Banwell B, Weinstock-Guttman B. Clinical features of children and adolescents with multiple sclerosis. Neurology 2007;68;S37-S45.

Callen D, Shroff M, Branson H, Lotze D, Li D, Stephens D, Banwell B. MRI in the diagnosis of pediatric multiple sclerosis. Neurology 2009;72:961-967.

Sobocki P, Pugliatti M, Lauer K, Kobelt G. Estimation of the cost of MS in Europe: extrapolations from a multinational cost study. Multiple Sclerosis 2007;13:1054-64.

Banwell B, Shroff M, Ness JM, J effery D, Schwid S, Weinstock-Guttman B. MRI features of pediatric multiple sclerosis. Neurology 2007;68 (suppl 2):S46–S53.

Neuteboom RF, Ketelslegers IA, Boon M et al. Barkhof magnetic resonance imaging criteria predict early relapse in pediatric multiple sclerosis. Pediatr Neurol 2010;42:53-5.

Sadaka Y, Verhey LH, Shroff M et al on behalf of the Canadian Pediatric Demyelinating Disease Network. 2010 Mc Donald Criteria for diagnosing pediatric multiple sclerosis. Ann Neurol 2012;72:211-223.

Link H, Huang YM. Oligoclonal bands in multiple sclerosis cerebrospinal fluid: an update on methodology and clinical usefulness. J Neuroimmunology 2006; 180: 17–28.

Chitnis T. Disease-modifying therapy of pediatric multiple sclerosis. Neurotherapeutics 2013;10:89-96.

D’Alessandro R, Vignatelli L, Lugaresi A et al. Risk of multiple sclerosis following clinically isolated syndrome: a 4-year prospective study. J Neurol 2013; 10.1007/s00415-013-6838-x

Bolcaen J, Acou M, Mertens K et al. Structural and metabolic features of two different variants of multiple sclerosis: a PET/ MRI study. J Neuroimaging 2012;XX:1-6.

Eckstein C, Saidha S, Levy M. A differential diagnosis of central nervous demyelination: beyond multiple sclerosis. J Neurol 2012;259:801-816.

Absound M, Wassmer E. Childhood CNS inflammatory demyelinating diseases. Pediatr Child Health 2010;20:404-410.

Mayringer I, Timeltaler B, Deisenhammer F. Correlation between the IgG index, oligoclonal bands in CSF, and the diagnosis of demyelinating diseases. Eur J Neur 2005; 12:527-530.

Mitosek-Szewczyk K, Gordon-Krajcer W, Flis D, Stelmasiak Z. Some markers of neuronal damage in cerebrospinal fluid of multiple sclerosis patients in relapse. Folia Neuropathol 2011;49:191-196.

Ghezzi A, Banwell B, Boyko A et al. The management of multiple sclerosis in children: A European view. Multiple sclerosis 2010;16:1258-1267.

Yeh EA, Weinstock- Guttman B. The management of pediatric multiple sclerosis. J Child Neurol 2012;27:1384-1393.

Chitnis T, Tenembaum S, Banwell B et al and for the International Pediatric Multiple Sclerosis Study Group. Consensus statement: evaluation of new and existing therapeutics for pediatric multiple sclerosis. MSJ 2012; 18:116-127.

Pohl D, Waubant E, Banwell B et al. Treatment of pediatric multiple sclerosis and variants. Neurology, 2007; 68: S54 - S65.

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Published

2013-12-30

How to Cite

Jamroz, E., Paprocka, J., Pietruszewski, J., Bojda, A., & Betkiewicz, A. (2013). Multiple sclerosis in children – clinical aspects and diagnostic dilemmas. European Journal of Clinical and Experimental Medicine, 11(4), 501–508. Retrieved from https://journals.ur.edu.pl/ejcem/article/view/12614

Issue

Vol. 11 No. 4 (2013): Medical Journal of the Rzeszow University and the National Medicines Institute, Warsaw

Section

ORIGINAL PAPERS

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Copyright (c) 2013 Medical Journal of the Rzeszow University and the National Medicines Institute, Warsaw

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