The clinical manfestations of multiple sclerosis (MS) in 14 children are reported from the Universidade de Sao Paulo, Brazil. Age at onset ranged from 2 to 15 years. Initial symptoms varied from minor motor impairment, visual disturbances, bladder dysfunction and paresthesias, to a diffuse encephalopathy, with impaired consciousness. All had a relapsing-remitting course, and one died 6 months after onset with disseminated demyelinating lesions. CT showed demyelination in 6 of 9 patients. MRI showed white matter lesions in the brainstem or cerebral hemispheres in 5 of 6 patients. CSF pleocytosis occurred in 8 of 23 attacks, and g-globulin levels were increased in 7. Visual evoked potentials (VEP) were abnormal in 7 of 8 patients; BAEP in 4 of 8: and SEP in 4 of 8. The importance of paraclinical examinations in diagnosis is emphasized. [1]
COMMENT. The 14 cases were seen in a period of 12 years. Four presented before 5 years of age, and the youngest was 2 years.
According to a report from the George-August University, Gottingen, Germany, published in the review International MS Journal (Hanefeld FA. Int. MSJ 1995;1:90-97), 24 cases with MS onset before age 5 years have been published since 1969. In 20 of 39 new patients studied over a 5-year period in Gottingen, the onset was before 10 years. The onset or relapse was preceded by a nonspecific infection, usually an URI, in >50%. Of 8 presenting with optic neuritis, 4 developed MS within 2 years. CSF maximal cell count was 900/ml, and protein was increased >100 mg%. Oligoclonal bands were absent in one third. VEPs were more frequently abnormal than BAEP and SEP. MRI sometimes showed new lesions without accompanying symptoms or relapse, and remissions were not always reflected in less MRI changes. Patients with juvenile onset (>10 years) followed a more severe, frequently relapsing, course than those with onset before puberty.