Very Rare Incident of Pediatric Onset Multiple Sclerosis Complicated with Status Epilepticus: A Case Report

Case Report

Austin Neurol & Neurosci. 2023; 6(1): 1028.

Very Rare Incident of Pediatric Onset Multiple Sclerosis Complicated with Status Epilepticus: A Case Report

Calcii Cornelia¹; Aminov David¹*; Sprincean Mariana¹; Marga Semion¹; Anton Paduraru Dana Teodora²; Revenco Ninel¹; Groppa Stanislav¹; Palii Ina¹; Pirtu Lucia¹; Hadjiu Svetlana¹

1Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova

2Department of Mother and Child Medicine, Grigore T.Popa University of Medicine and Pharmacy Iasi, Romania

*Corresponding author: David Aminov Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova. Email: david353aminov@gmail.com

Received: August 01, 2023 Accepted: August 23, 2023 Published: August 30, 2023

Abstract

Background: Pediatric Onset Multiple Sclerosis (POMS) is a chronic inflammatory disease in the central nervous system that affects children under 18. Children with POMS experience gradual deterioration leading to increased disability and lower life expectancy [1,2].

The Purpose of the Study: To present a rare case of POMS with an onset at 42 months, emphasizing its significance due to its infrequency in this age group. The hope is to encourage the establishment of specific diagnostic and treatment guidelines for POMS in the near future.

Material and Methods: The evolution of POMS in a 3.6-year-old child who was admitted multiple times to the Hospital of Mother and Child Health Care in the Republic of Moldova during acute MS attacks.

Results: In September 2022, the child received a confirmed POMS diagnosis based on McDonald’s criteria (2017), which was later confirmed in April 2023 through OCB-CSF examination. The April 2023 MRI showed changes in demyelination foci with temporary clinical improvement compared to the previous examination after the last acute attack. The child is currently undergoing five days of plasmapheresis, followed by a tapering regimen of oral steroids. Ongoing MRI monitoring is recommended, with consideration of receiving Disease-Modifying Treatments (DMTs) in Romania, where they are approved.

Conclusions: This rare case highlights the importance of raising awareness about POMS in children. Early detection and intervention could lead to the development of new diagnostic and treatment guidelines. However, the lack of access to DMT drugs for POMS treatment in the Republic of Moldova results in significantly lower survival rates compared to other countries.

Introduction

Multiple Sclerosis (MS) is a chronic inflammatory disease targeting myelinated axons in the central nervous system. It exhibits varying degrees of disability, affecting some mildly while others experience gradual deterioration with heightened disability. More prevalent in women, MS is typically diagnosed in the late 20s to early 30s. Despite slightly reduced life expectancy, proper management is crucial to prevent secondary complications [3].

Pediatric MS, also known as Pediatric-Onset Multiple Sclerosis (POMS), occurs before age 18. Its exact cause remains elusive, but factors such as infectious agents (EBV), environmental influences (vitamin D deficiency), and genetic predisposition (HLA-DR2) have been linked to it. POMS symptoms commonly affect cognition, vision, neuromuscular functions, pulmonary, and the renal system. According to studies, the frequency of POMS in children is 5% of all the patients with MS, whereas the onset of POMS before the age of 10 years is observed in less than 1% of patients [3]. Even though neuroplasticity is present in individuals with POMS, they tend to develop similar levels of disability at a much earlier age compared to those with Adult-Onset MS (AOMS). Consequently, their quality of life is frequently compromised, negatively affecting their education, social life, and physical activities. As a result, POMS must be viewed as a severe and highly disabling disease that comes with significant social costs [4-6].

Case Report

T.N., born on September 30th, 2019, was admitted to the Hospital of Mother and Child Health Care in the Republic of Moldova on 28/04/22 with complaints of vomiting, fatigue, somnolence, and loss of appetite. She had flu-like symptoms for the past 4 days, and previous treatment showed no improvement. On the 7th day of hospitalization, she developed right-side convergent strabismus with peripheral palsy. A cerebral MRI revealed multiple pathological foci in the white matter supra and infra-tentorially (Figure 1-4). A preliminary diagnosis of Acute Disseminated Encephalomyelitis (ADEM) was made, and treatment with I.V methylprednisolone (30 mg/kg for 3 days) followed by an oral steroid taper significantly improved the strabismus.