Clinical Analysis Of 9 Cases Of Multiple Sclerosis In Children

Objective:The clinical manifestations,auxiliary examinations,diagnostic criteria,differential diagnosis and treatment of 9 children with multiple sclerosis were analyzed.The prognosis and therapeutic effect were observed through follow-up,so as to improve the diagnosis and treatment level of children with MS.Methods:By means of retrospective analysis and referring to the Diagnostic Criteria of Multiple Sclerosis and Other Central Nervous System Demyelinating Diseases in Children(2012 edition),9 children with MS were selected from the children hospitalized in the Department of Neurology of our hospital from January 2014 to February 2018,and their clinical data were collected.Including age,sex,incentives,clinical symptoms,laboratory tests,imaging(MRI diagnostic criteria referring to the "Diagnostic criteria of multiple sclerosis imaging: consensus of Chinese experts"),clinical electrophysiological examination,treatment,etc.Through outpatient or telephone follow-up,to summarize and analyze.Results:1.Among 9 children with MS,3 were male and 6 were female,male: female is 1:2.The onset age was 4 years 3 months to 12 years 7 months.The average age was 7 years 8months.The proportion of children aged less than 10 years old was higher(78%).2.The first symptoms are visual impairment,ataxia,headache,dizziness,vomiting,lower extremity hemiplegia,central facial paralysis,convulsions,dysuria and so on.One or more symptoms can occur simultaneously.Recurrent symptoms included decreased vision,ataxia,headache,dizziness,vomiting,lower extremity hemiplegia and central facial paralysis.All parts of the central nervous system can be involved,such as the brain,cerebellum,spinal cord,optic nerve and so on.Therefore,the clinical manifestations are varied and difficult to identify early.3.There were 3 cases(33%)with OB positive in CSF of 9 MS children.The abnormal changes of VEP could occur earlier,4 cases(44%)with abnormal VEP.The overlap ratio of visual acuity decline and abnormal VEP was 1:1.3.4.All 9 MS children had abnormal MRI examinations.The first lesions involved the brainstem,cerebellum,subcortical white matter,paraventricle,cervical and thoracic segments of the spinal cord,followed by thalamus,basal ganglia,internal capsule,corpus callosum and hippocampus.The recurrent lesions were mainly in the brainstem,subcortical white matter,cerebellum,paraventricle and basal ganglia,followed by cerebrospinal spine and cervix.Thoracic segment,thalamus,corpus callosum,hippocampus and internal capsule.At the same time,there were 4 lesions,such as subtentorial(brainstem,cerebellum),subcortical white matter,paraventricular and spinal cord lesions in 2 cases(22%),3 lesions such as subtentorial(brainstem,cerebellum),subcortical white matter and paraventricular lesions in 4 cases(44%)and 2 lesions such as subtentorial(brainstem,cerebellum)and subcortical white matter lesions in 3 cases(33%).4 cases(44%)of recurrent children had both old and new lesions.The combination of lesions involving subtentorial(brainstem,cerebellum),subcortical white matter and paraventricular lesions was the most common.5.High-dose methylprednisolone pulse therapy(20mg/(kg.d))was the first choice for MS children in this group,and 6 cases(67%)were effective;1 case of ataxia had no significant improvement in clinical symptoms after hormone and C-ball impulse therapy,and was significantly improved after plasma exchange;1 case of MS was treated with rituximab(merohua)and relapsed about 8.5 months before treatment.Once,no recurrence occurred nearly 10 months after treatment.6.All patients were followed up for 1 to 4 years and 1 to 4 times.The recurrence rate was 78%.The shortest recurrence interval was 3 months and the longest recurrence interval was 2 years and 5 months.Visual impairment,limb movement disorder,learning disability and cognitive impairment were the common sequelae.There were 3 cases(33%)with learning,cognitive impairment and irritability,and 2 cases(22%)with mild mental retardation.Conclusion:1.9 children with MS had sex ratio of 1:2 and 78% were under 10 years old..2.Children with MS may have one or more symptoms at the same time.The most common symptoms of MS are visual impairment,headache and dizziness.The most common symptoms of MS recurrence are visual impairment and ataxia.3.The routine and biochemical changes of cerebrospinal fluid in children with MS were not specific.The positive rate of OB in cerebrospinal fluid was 33%.4.Head MRI showed that the most frequently involved parts of the first lesion of MS in children were brainstem and subcortical white matter,and the most frequently involved parts of recurrent lesions were brainstem,cerebellum and subcortical white matter.At the same time,4 lesions accounted for 22%,3 lesions accounted for 44%,2lesions accounted for 33%,and the coexistence of old and new lesions accounted for44%.5.6/9(67%)of MS children were treated with high-dose hormone shock for the first time in acute phase,and 1/9 children were treated with high-dose hormone shock again one week later.The other 1/9 children were treated with plasma exchange and their symptoms improved significantly.In 1/9 children with recurrent disease,the clinical symptoms improved significantly and the recurrence time prolonged after rituximabtreatment in remission stage.6.The recurrence rate of MS in children was as high as 78% within one year.33%of the children had physical disability,33% of the children had cognitive impairment,irritability and 22% had mild mental retardation.