MULTIPLE SCLEROSIS IN THE TROPICS

Objectives: Multiple sclerosis (MS) is not commonly seen in children, more so amongst Asian children living in the tropics. We report four cases of definite relapsing-remitting multiple sclerosis, and a fifth child with a florid first demyelinating episode and a high risk towards developing subsequent MS, occurring in Malaysian children.

Methods: Five children were seen over the last three years (January 2003 till October 2005). The children with definite MS fulfilled MacDonald's criteria for dissemination in time and space, whilst the child with high risk for MS fulfilled criteria for dissemination in space.

Results: Age of onset ranged from 4 to 10 years. All four children (two girls, two boys) with definite MS had an initial optic neuritis of insidious onset, followed by subsequent symptomatic and silent demyelinating syndromes involving the brain and spinal cord. Long segment contiguous lesions were seen when the spinal cord was involved. Clinical symptoms included deterioration in vision, aphasia, cerebellar dysfunction, hemiparesis, monoparesis or quadriparesis, paraparesis and sphincteric involvement. All clinical episodes improved with intravenous methylprednisolone and oral prednisolone. The first child we saw had five relapses before receiving prophylactic interferon beta-1a, experiencing a further single relapse after a year on treatment. Two other children have recently been started on interferon beta-1a after the second episode. The boy with high risk for MS had a first demyelinating episode with bilateral optic neuritis and multiple gadolinium enhancing perpendicular periventricular and callosal lesions, with complete resolution after treatment with steroids.

Conclusion: Multiple sclerosis is seen in Asian children. The disease in these children may have a preponderance towards optic neuritis and spinal cord syndromes.