EARLY ONSET MS – A RETROSPECTIVE STUDY

Objectives: Evaluation of the clinical course, CSF, MRI and VEP findings in childhood onset MS.

Methods: 29 patients with onset of MS before the age of 16 were included. Clinical course, relapse rate, EDSS, brain MRI, CSF, VEP and type of treatment were analysed.

Results: Among 1100 patients of our MS cohort 29 (2.6%) met inclusion criteria. (9 males,20 females). The mean age of onset was 12 years (min=3.5, max=16). The duration of observation was 1–18 years. (mean=7) Initial symptoms: brainstem 51.7%, pyramidal 24.1%, optic neuritis 13.8%, sensory symptoms 10.3%. Brain MRI was abnormal in all patients at onset, CSF oligoclonal bands were found in 89.7% and VEP were abnormal in 93.1% patients. The mean EDSS was 2.7 (1.5–4.0) at onset and 1.6 (0–6.5) at the end of the study. Mean relapse rate was 0.96. In most cases relapsing-remitting course was seen. Primary progressive MS was not diagnosed in any of the patients. Two subjects developed a secondary progressive form. Treatment: In addition to steroids, some patients were treated with either interferons or copaxone, high dose of IVIG in pulses or azathioprine. High dose immunoablative therapy with autologous stem cells was performed in two cases with malignant course (with favourable outcome).

Conclusion: The characteristics of EOMS, including prognosis, are similar to those in adults. EOMS is rarely associated with malignant course. However in patients with progressive disability aggressive treatment and early use of DMDs is justified.