Diagnosis and management of multiple sclerosis and other relapsing demyelinating disease in childhood

Smith, Aphra Luchesa; Sudarsan, Nikil; Hemingway, Cheryl; Lim, Ming

doi:10.1136/archdischild-2021-321911

Cited by 2 publications

(1 citation statement)

References 29 publications

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“…The first demyelinating event or ADS in children ≤18 years can have a very varied clinical and radiological expression. The main diagnoses that encompass an ADS in the pediatric age are acute disseminated encephalomyelitis (ADEM), multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein (MOG) antibody disease (MOGAD) (Luchesa Smith et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Diagnostic challenge in children with an acquired demyelinating syndrome: an illustrative case report

et al. 2023

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The clinical-radiological and biological overlap of the spectrum of pediatric demyelinating disorders makes the diagnostic process of a child with an acquired demyelinating syndrome truly challenging. We present a 9-year-old girl with subacute symptoms of severe decrease in bilateral visual acuity and gait ataxia. An urgent MRI showed inflammatory-demyelinating lesions affecting the periaqueductal gray matter, the cerebellar hemispheres, the area postrema as well as both optic nerves and chiasm. Likewise, multisegmental involvement of the cervical and dorsal spinal cord was found, with short and peripheral lesions. Anti myelin oligodendrocyte glycoprotein (MOG) antibodies (Abs) were positive in cerebrospinal fluid (CSF) and weakly in serum. Oligoclonal bands (OB) were positive in CSF. Based on all this, the diagnosis of MOG antibody disease (MOGAD) with a neuromyelitis optica spectrum disorder (NMOSD)-like picture was made. Given the good clinical and radiological recovery after the acute phase treatment, and that anti MOG Abs became negative, it was decided to keep the patient without specific treatment. However, during follow-up, while the patient was asymptomatic, a control brain MRI showed the appearance of new lesions with morphology and topography suggestive of multiple sclerosis (MS). This, added to the presence of OB, made the diagnosis of pediatric-onset MS (POMS) likely. Immunosuppressive treatment was restarted with a good response since then. Unlike adult-onset MS, children with POMS may usually not have entirely typical clinical and radiological features at presentation. In many cases, the time factor and close clinical and radiological monitoring could be critical to make an accurate diagnosis.

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Section: Introductionmentioning

confidence: 99%

Diagnostic challenge in children with an acquired demyelinating syndrome: an illustrative case report

et al. 2023

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

Pierce Pucci,

Soloria,

Eye

2024

J Telemed Telecare

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Pediatric-onset multiple sclerosis (POMS) is the most common demyelinating disease in children. Patients suffer from physical disability, cognitive impairment, and psychosocial challenges. Management requires a multidisciplinary care team. Here we present a case of an 11-year-old boy with POMS who relocated to Guam prior to initiation of a disease-modifying treatment and who experienced a flare without immediate access to an MRI or a child neurologist. Care required the combined efforts of ophthalmology, pediatrics, and emergency medicine in Guam, real-time remote guidance by child neurology, and asynchronous collaboration with cardiology and child neurology. As a result, the immediate flare was accurately diagnosed and treated with steroids, the patient was started on Fingolimod, and an emergency management plan for future flares was constructed. This case illustrates the nuances of both the acute and chronic management of multiple sclerosis in a resource-limited setting and how a combination of synchronous and asynchronous telemedicine was able to achieve a satisfactory treatment plan.

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Diagnosis and management of multiple sclerosis and other relapsing demyelinating disease in childhood

Cited by 2 publications

References 29 publications

Diagnostic challenge in children with an acquired demyelinating syndrome: an illustrative case report

Diagnostic challenge in children with an acquired demyelinating syndrome: an illustrative case report

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

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