Childhood multiple sclerosis and allied demyelinative diseases

• Published in: No to hattatsu Vol. 31; no. 1; p. 44
• Main Authors: Imai, M, Tanaka, M, Hamano, S, Nara, T, Maekawa, K
• Format: Journal Article
• Language: Japanese
• Published: Japan 01.01.1999
• Subjects: Biomarkers - cerebrospinal fluid; Child; Child, Preschool; Demyelinating Diseases - diagnosis; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Infant; Magnetic Resonance Imaging; Male; Multiple Sclerosis - diagnosis; Phosphopyruvate Hydratase - cerebrospinal fluid
• ISSN: 0029-0831
• DOI: 10.11251/ojjscn1969.31.44

We report five cases of multiple sclerosis (MS) and three cases of allied demyelinative diseases starting during childhood. Three of the MS patients presented with atypical initial symptoms, such as acute encephalitis or myelitis, making an early clinical diagnosis difficult. Ophthalmologic symptoms were noted in four of MS children, and in two with allied demyelinative diseases. Therefore, if a child shows ophthalmologic symptoms (i.e. optic neuritis, ophthalmoplegia), brain magnetic resonance imaging (MRI) should be conducted for the differential diagnosis of MS and other demyelinative diseases. Cerebrospinal fluid analysis is not useful for the initial diagnosis of MS, because pleocytosis and increase of oligoclonal IgG band in cerebrospinal fluid are seen in both MS and other demyelinative disorders. However, neuron specific enolase (NSE) is slightly higher in the latter than in the former. T2-weighted MRI of multiple sclerosis showed multiple high intensity areas in the white matter of the cerebrum and cerebellum, capsula interna, and crus cerebri etc. Most of these lesions were clinically silent, being characteristic of MS. In two MS cases, however, initial MRI revealed no abnormal findings. Thus, the diagnosis of MS can not be made by initial MRI only.