1,721,014 research outputs found
Multiple sclerosis in children and adolescents
No full textMultiple sclerosis (MS) is considered to be a disease of young adulthood, but it should be noted that cases in childhood and adolescence are not rare. Principally, childhood MS and MS in the adult age are the same disease. Nevertheless, there are some important differences concerning possible differential diagnoses, symptoms, clinical course and therapy. Of special interest is the fact that the prognosis of MS in childhood seems to be better than that of MS in the adult age, partially as a consequence of the lower percentage of primary and secondary progressive courses. Despite the fairly good prognosis of childhood MS, a consequent immunosuppressive treatment of acute attacks as well as a timely immunomodulatory therapy to slow down the progression of the disease is to be recommended. Yet the potential therapeutic benefit of such a treatment has to be carefully balanced against the presently unknown long-term risks of an immunomodulation early in life. Additionally, pharmacotherapy of childhood MS should always be part of a comprehensive therapeutic concept also considering physiotherapeutic and individual psychosocial care
Multiple sclerosis in childhood
No full textChildhood multiple sclerosis (MS) cannot be considered a rare disease since it constitutes about 5% of all MS-cases. A survey of cases in Germany showed over 150 new cases of definite or probable childhood MS from 1997 to 1999, the reel incidence of MS in childhood is most probably even higher. principally adult and childhood MS are the some disease but there ore important differences in possible differential diagnoses, symptoms, clinical course and therapy It is especially interesting that the prognosis in childhood MS appears to he better than in adult MS, mainly as a consequence of the lower percentage of primary and secondary progressive courses. Despite the better prognosis in childhood MS, a consequent immunosuppressive treatment of acute attacks as well as immunomodulatory therapy at the proper point in time to slow down the progression of the disease are recommended. The potential benefits of immunomodulation have to be balanced against the presently unknown long-term risks of such a therapy early in life
Multiple sclerosis in childhood
No full textChildhood multiple sclerosis (MS) cannot be considered a rare disease since it constitutes about 5% of all MS-cases. A survey of cases in Germany showed over 150 new cases of definite or probable childhood MS from 1997 to 1999, the reel incidence of MS in childhood is most probably even higher. principally adult and childhood MS are the some disease but there ore important differences in possible differential diagnoses, symptoms, clinical course and therapy It is especially interesting that the prognosis in childhood MS appears to he better than in adult MS, mainly as a consequence of the lower percentage of primary and secondary progressive courses. Despite the better prognosis in childhood MS, a consequent immunosuppressive treatment of acute attacks as well as immunomodulatory therapy at the proper point in time to slow down the progression of the disease are recommended. The potential benefits of immunomodulation have to be balanced against the presently unknown long-term risks of such a therapy early in life
The use of interferon-beta-1a (Rebif((R))) in children and adolescents with multiple sclerosis
No full textBalo's concentric sclerosis associated with primary human herpesvirus 6 infection
No full textBackground: Balo's concentric sclerosis (BCS) is a demyelinating disorder believed to be a rare variant of multiple sclerosis ( MS). Human herpesvirus 6 (HHV-6) is a highly neurotropic virus causing severe central nervous system (CNS) infections predominantly following reactivation of latent HHV-6 in immunocompromised individuals. Primary infection with HHV-6 usually occurs in early childhood manifesting as exanthema subitum. The clinical spectrum of primary infection in adolescents or adults has not yet been evaluated. Case report: A previously healthy 13 year old girl developed acute hemianopsia and anomia 5 days after an episode of fever and malaise of unknown origin. Cerebral MRI revealed three white matter lesions, one with ring-like contrast enhancement. Lumbar puncture showed mononuclear pleocytosis of 30 cells/mu l, oligoclonal IgG, and a normal protein level. Follow up cerebral MRI scans revealed lamellar concentric hemispheric lesions characteristic of BCS. The first neurological symptoms of the patient coincided with primary HHV-6 CNS infection, diagnosed by a positive PCR test of the CSF together with seroconversion. Response to antiviral and corticosteroid treatment was only temporary, but immunoglobulin treatment has so far been followed by clinical stability for 30 months. Conclusions: To our knowledge, this is the first report both of an association between HHV-6 and BCS and of immunoglobulin treatment of BCS. A late primary infection with HHV-6 might be associated with BCS. Further studies in patients with this rare disease are needed to confirm this association and to evaluate the efficacy of antiviral and immunoglobulin treatment
Recurrent optic neuritis associated with Chlamydia pneumoniae infection of the central nervous system
No full textIt has been suggested that Chlamydiapneumoniae (C. pneumoniae) is involved in the pathogenesis of diverse diseases of the central nervous system (CNS), including multiple sclerosis. We report the case of a 12-year-old male with isolated recurrent optic neuritis and an associated CNS infection with C. pneumoniae. The patient presented with three attacks of optic neuritis within 5 months. A positive polymerase chain reaction for C. pneumoniae in the cerebrospinal fluid led to the diagnosis of a CNS infection with C pneumoniae. After treatment with the antibiotic rifampicin, he experienced no further attacks during the follow-up period of 6 years. These findings suggest the possibility of a C pneumoniae infection as a contributing factor or even causative event for the development of optic neuritis
Paediatric and adult multiple sclerosis: age-related differences and time course of the neuroimmunological response in cerebrospinal fluid
No full textWe investigate common pathophysiology in paediatric and adult multiple sclerosis (MS) by comparison of cerebrospinal fluid (CSF) data. We compared cerebrospinal fluid (CSF) data from eight patient groups with onset of MS at 7 to 29 years (n = 184). A new statistics program allows sensitive detection, quantifies the mean amount of intrathecal Ig synthesis in groups based on the 96% reference range of 4100 non-inflammatory controls, corrects for age-related increase of blood-derived albumin and immunoglobulins in CSF, and presents graphical data interpretation in Reibergrams. Already at onset of MS before puberty (<= 10 years) the frequency of intrathecal IgG synthesis (oligoclonal IgG) was 100% like in adults with 98%, but the amount of intrathecal IgG increases twofold during puberty. Intrathecal IgM synthesis is most frequent before and during puberty (in 57-67% of patients) compared with 41% in adults. The amount of intrathecal IgM synthesis before puberty is only 30% of that in adults. IgG and IgM Index are biased evaluations not suitable for characterizing age-related dynamics. A twofold age-related increase of the albumin quotient, Q(Alb), as a measure of the blood-CSF barrier function, represents normal physiological growth. Cell counts in CSF are low. The pre-puberty gender ratio is about 1:1. Intrathecal antibodies against measles, rubella and/or varicella zoster virus are detected in 73% of patients before puberty compared with 89% of adults. Individual paediatric patients (n = 17), with sequential punctures over 2-5 years, show constant quantities of intrathecal IgM and specific antibodies. In conclusion, paediatric MS already at first clinical manifestation shows the complete, neuroimmunological data pattern in CSF, i.e. inflammatory signs are not gradually evolving. Paediatric and adult MS differ quantitatively but not qualitatively in neuroimmunological patterns which does not allow for discrimination between 'early' and 'late' onset MS. CSF analysis may help to discriminate between acute and monosymptomatic chronic inflammatory disease already at earliest clinical manifestation
Paediatric multiple sclerosis and acute disseminated encephalomyelitis in Germany: results of a nationwide survey
No full textThe aim of this study was to evaluate the incidence of paediatric multiple sclerosis (MS) and acute disseminated encephalomyelitis (ADEM) in Germany. In a prospective nationwide survey carried out between 1997 and 1999, all registered new cases of paediatric MS and ADEM with an onset before the age of 16 years were evaluated using a standardised questionnaire. A total of 132 patients with suspected or definite MS and 28 patients with an assumed diagnosis of ADEM were reported. Among these, 82% of the MS patients were 10 years of age or older, as opposed to 18% in the ADEM-cohort. The female-to-male ratio was 1.2:1 in the MS-cohort and 0.8:1 in the ADEM-cohort. Manifestation was polysymptomatic in 67% of the MS patients compared to 86% of the ADEM patients. The most frequent primary symptoms in the MS-cohort were cerebellar (44%), sensory (39%) or visual (36%), followed by brainstem (30%), pyramidal (29%) and cerebromental (22%) complaints. Conclusion: The incidence of paediatric MS in Germany is more than fourfold higher than that of paediatric ADEM; in addition, it shows a strikingly different age-distribution. With an estimated minimum of 50 new cases per year, the incidence of paediatric MS in Germany is much more frequent than previously believed
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