Multiple Sclerosis in a Pediatric Point of View: A Case Report

Background: Multiple Sclerosis (MS) is an immune-mediated disorder characterized by episodes of demyelination in the Central Nervous System (CNS). Pediatric MS is increasingly recognized, mostly in females, usually presenting as an isolated syndrome (eg. optic neuritis). Diagnosis usually involves Brain Magnetic Ressonance (MRI), Cerebrospinal fluid (CSF) analysis and McDonald criteria for dissemination in space and time. Pulse intravenous methylprednisolone is used in acute attacks. Relapsing-remitting MS (RRMS) is the initial form in 97-99% and the recommended treatment is disease-modifying therapy (injectable or oral).

Objective: Describe a MS case in pediatric age, emphasizing the need for greater awareness of this entity.

Case Report/Results: A 12 year-old girl, previously healthy, complains of sudden onset of paresthesias, right upper limb paresis with inability to write. Symptoms started 5 days before, after her dog death. Examination showed altered fine mobility, right dysmetria and asymmetric gait. Normal Computed Tomography. MRI revealed several areas of hyperintensity in T2-sequences, the major on left pons, suggesting active MS lesions. She was admitted to a Neuropediatric Department and received a methylprednisolone pulse. CSF showed oligoclonal bands and intrathecal synthesis of IgG and IgM. Two months later, Interferon beta-1a was initiated. Meanwhile, she had another relapse with headache, dysarthria, right paretic gait and limb paresthesias correlating with two new lesions on MRI. Currently, she shows good clinical and imaging evolution.

Conclusion: This adolescent has a typical pediatric MS presentation, with typical space-time dissemination pattern and two separated clinical attacks involving different areas of CNS. The recent loss of her dog could have led to a misdiagnosed somatization disorder, emphasizing that in this age group some confusion factors can come in the way to a good diagnosis.