1. Gilenya - Test 2

Gilenya - Test 2

The Clues

Can Be Clear
Identify multiple sclerosis (MS) early.
 
Rob Sofia Ana

 

Patient Stories

Rob, aged 14 years

Not an actual

patient with MS

School level: Secondary



Hobbies: Horseback riding, football, gaming

Initial Presentation



Physical

 

  • Dizziness, clumsy gait, reduced sensation in legs; now struggling in favorite sports



Cognitive

  • Difficulty finishing school lessons, trouble concentrating, fatigue



Emotional

  • Anxiety, uncooperative in school, exhibiting inappropriate behaviors, directing anger at parents and siblings

 

+
  Test Results:
     
  • Impaired sensation below T8-T9
     
  • Below-average scores on Brief Repeatable Battery of Neuropsychological Tests (BRB-N) in executive function, processing speed, and word retrieval

Sofia, aged 12 years

Not an actual

patient with MS

School level: Secondary



Hobbies: Swimming, coding

Initial Presentation

Physical

  • Blurred vision, pain with eye movement



Cognitive

  • Withdrawn, sad

 

+
  Test Results:
     
  • Increased latencies and reduced amplitudes of wave forms on visual evoked potentials (VEP) test
     
  • Oligoclonal banding proteins in the CSF following lumbar puncture
     
  • Brain MRI exhibits multiple T2 lesions in the cerebral white matter

Ana, aged 16 years

Not an actual

patient with MS

School level: Secondary



Hobbies: Drama, reading

Initial Presentation

Physical

  • Tingling sensation in legs, fatigue, bladder control problems



Cognitive

  • Slurred speech, trouble concentrating



Emotional

  • Withdrawn, sad

 

+
  Test Results:
     
  • Slightly elevated CSF proteins and CSF glucose following lumbar puncture
     
  • Spinal MRI exhibits 2 T2 lesions
     
  • Brain MRI exhibits multiple T2 lesions in the cerebral white matter

 

Learn more about the impact of MS in children  >
Follow the clues in your pediactric patients with this downloadable questionnaire about MS symptoms. 
Identifying MS early can make all the difference. Partner with a multidisciplinary care team, including a neurologist or pediatric neurologist, upon early suspicion of MS in your young patients. 

 

+
References:
 

1. Chitnis T, Glanz B, Jaffin S, Healy B. Demographics of pediatric-onset multiple sclerosis in an MS center population from the Northeastern United States. Mult Scler. 2009;15(5):627-631. 2. National Multiple Sclerosis Society. https://www.nationalmssociety.org/. Published August 27, 2018. Accessed April 19, 2019. 3. Belman AL, Krupp LB, Olsen CS, et al. Characteristics of children and adolescents with multiple sclerosis. Pediatrics. 2016;138(1):e20160120. 4. Ghezzi A, Baroncini D, Zaffaroni M, Comi G. Pediatric versus adult MS: similar or different? Mult Scler Demyelinating Disord. Published online May 7, 2017. doi:10.1186/s40893-017-0022-6. 5. Renoux C, Vukusic S, Mikaeloff Y, et al. Natural history of multiple sclerosis with childhood onset. N Engl J Med. 2007;356(25):2603-2613. 6. Pena JA, Lotze TE. Pediatric multiple sclerosis: current concepts and consensus definitions. Autoimmune Dis. 2013;2013:673947. 7. Alroughani R, Boyko A. Pediatric multiple sclerosis: a review. BMC Neurol. 2018;18(1):27. doi:10.1186/s12883-018-1026-3. 8. Lulu S, Graves J, Waubant E. Menarche increases relapse risk in pediatric multiple sclerosis. Mult Scler. 2016;22(2):193-200. 9. Chabas D, Green AJ, Waubant E. Pediatric multiple sclerosis. NeuroRx. 2006;3(2):264-275. 10. Venkateswaran S, Banwell B. Pediatric multiple sclerosis. Neurologist. 2010;16(2):92-105. 11. Mellen Center Approach: Pediatric Onset Multiple Sclerosis. Cleveland Clinic. https://my.clevelandclinic.org/-/scassets/files/org/neurological/multipl.... Accessed April 19, 2019. 12. Ghezzi A. Pediatric multiple sclerosis: epidemiology, clinical aspects, diagnosis and treatment. Neurodegener Dis Manag. 2017;7(6s):23-25. 13. Pediatric Multiple Sclerosis. Cleveland Clinic. https://my.clevelandclinic.org/ccf/media/files/Multiple_sclerosis_center.... Accessed April 19, 2019. 14. Jancic J, Nikolic B, Ivancevic N, et al. Multiple sclerosis in pediatrics: current concepts and treatment options. Neurol Ther. 2016;5(2):131-143. 15. Chitnis T, Arnold DL, Banwell B, et al. Trial of fingolimod versus interferon beta-1a in pediatric multiple sclerosis. N Engl J Med. 2018;379(11):1017-1027. 16. Amato MP, Krupp LB, Charvet LE, et al. Pediatric multiple sclerosis: cognition and mood. Neurology. 2016;87(suppl 2):S82-S87. 17. Waldman A, Ness J, Pohl D, Chitnis T. Pediatric multiple sclerosis: clinical features and outcome. Neurology. 2016;87(9 suppl 2):S74-S81. 18. Gorman MP, Healy BC, Polgar-Turcsanyi M, Chitnis T. Increased relapse rate in pediatric-onset compared with adult-onset multiple sclerosis. Arch Neurol. 2009;66(1):54-59. 19. Harding KE, Liang K, Cossburn MD, et al. Long-term outcome of paediatric-onset multiple sclerosis: a population-based study. J Neurol Neurosurg Psychiatry. 2013;84(2):141-147. 20. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983;33(11):1444-1452. 21. Aubert-Broche B, Fonov V, Narayanan S, et al. Onset of multiple sclerosis before adulthood leads to failure of age-expected brain growth. Neurology. 2014;83(23):2140-2146. 22. Kerbrat A, Aubert-Broche B, Fonov V, et al. Reduced head and brain size for age and disproportionately smaller thalami in child-onset MS. Neurology. 2012;78(3):194-201. 23. Nobis K, Bartels F, Anlar B, et al. Pediatric multiple sclerosis is associated with brain growth failure. Neuropediatrics. 2006;47. doi: 10.1055/s-0036-1583721. 24. MacAllister WS, Boyd JR, Holland NJ, et al. Neurology. 2007;68(16 suppl 2):S66-69. 25. Banwell B, Bar-Or A, Giovannoni G, Dale RC, Tardieu M. Therapies for multiple sclerosis: considerations in the pediatric patient. Nat Rev Neurol. 2011;7(2):109-122.

 



 

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