CLINICAL CHARACTERISTICS AND FOLLOW-UP OF MULTIPLE SCLEROSIS IN CHILDREN

Objectives: To study the diagnosis and relation between the Multiple Sclerosis (MS) and the viral encephalitis in children.

Methods: The 25 cases which were admitted to department of neurology from July 1994 to December 2004, and the MS diagnosed according to the criteria were analyzed.

Results: (1) The age of onset was 720/30 months to 123/12 years, and 23 children were younger than 10 years and 13 were younger than 5 years. (2) The most common symptom at initial onset was extremity palsy, seen in 13/25 cases. Follow it were convulsion (11/25), conscious disturbance (8/25), disturbance of vision (6/25). (3) The symptoms recurred for 3 to 6 times at intervals varied from 15 days to 11/2 years (in average 5 months). The clinical symptoms of 11 patients remitted completely after the first onset, and of 14 cases remitted partially. The course of the disease lasted for 7 months to 9 years. (4) Laboratory studies: The background activity at the first EEG were all the abnormal diffuse slow waves in all cases, including 7 asymmetric and 3 spike discharge. The marked abnormality in VEPs was detected in 8 of 11 cases, and whose P100 were delayed remarkably. The results of CT were abnormal in 8/11 cases, of whom 7 were presented multiple focal lesions of decreased density in white matter of periventricular area, and encephalatrophy was seen in 2 cases. MRI examination was preformed in 21 cases and white matter abnormalities were found in 20, of whom abnormal signals with T1,T2-weighted in different sizes and in white matter of periventricular regions in the frontal, parietal, temporal, occipital lobes and basal ganglia. CSF examination was preformed in 21 cases and routine normal were found in 20, and protein light adding was found in 5 cases. (5). Diagnosis at onset: 4 cases as optical neuritis, 3 as optical neuromyelitis, l1 as viral encephalitis, 4 as acute disseminated encephalomyelitis, 3 as dedemyeinating at the beginning, and the diagnosis was corrected as MS finally because of the frequent recurrence during the following 6 months to 2 years.

Conclusion: (1) MS is not rare one of neurologic problems in infants and children, and the diagnosis was mistaken easily at first onset. Viral encephalitis with the remission and recurrence should be considered as MS in children. (2) Extremity palsy, convulsion, conscious disturbance, disturbance of vision are the most common symptoms of MS in children. (3) VEP and following-up radiographic study, especially MRI are helpful laboratory studies for diagnosis of MS.