Demyelinating disorders in children

ABSTRACT

The study designed for early detection of demyelinating disorders in children through clinical, neuroimaging and laboratory study for proper differentiation between different types of demyelinating disorders [multiple sclerosis and acute disseminated encephalomyelitis] The present study included 15 patients with demyelinating. disorders, were selected from the pediatric neurology clinic in Al Azhar University hospitals in Cairo at the period from January, 2007 to December, 2008. All consecutive children with neurological abnormalities and evidence of demyelinating affection in brain MRI were included in this study and each one was subjected to the following detailed medical and neurological history, full general and neurological examination, brain MRI, Visual Evoked Potential, and laboratory assessment [Oligoclonal bands]. According to the clinical pictures, the most frequent clinical manifestations in demyelinating patients were motor dysfunction[93%], brain stem dysfunction[60%], altered mental status[46.5%], ataxia [46.5%], preceding illness[flu like symptoms][46.5%]. As regarding MRI findings, periventricular plaques [86.5%], brain stem plaques [73%], cortical grey matter [46.5%], subcortical white matter[46.5%], and cerebellar plaques [40%]. Visual Evoked potential was abnormal in all cases of multiple sclerosis, and normal in cases of ADEM. Oligoclonal Bands[OCB] was present in 80% of MS cases and 40% in patients with ADEM. Our results gives evidence that there are different clinical pictures for each disorder of demyelinating diseases and through the most frequent symptoms and initial presenting symptoms we can reach the diagnosis early. All the studied cases have abnormal MRI findings, thus MRI considered a high valuable tool for diagnosing both MS and ADEM. Selective laboratory assessments [e.g. OCB and VEP] are used to help and confirm the diagnosis of these different types of demyelinating disease