PP-045 A child with early onset multiple sclerosis

Aim Background: Multiple sclerosis (MS) is the most common autoimmune disorder of the central nervous system. The usual age of onset of multiple sclerosis is late 20s or early 30s and childhood onset multiple sclerosis is very rare. We report a case of a plausible onset of multiple sclerosis at the age of 4. ***** Clinical presentation: A 6 years and 4 months old girl presented to the Emergency Department with vomiting and unbalanced gait on a background history of right-sided weakness secondary to acute disseminated encephalomyelitis (ADEM) which occurred 2 years ago. Neurological examination revealed unbalanced gait, normal tone, normal reflexes, 4/5 power in all limbs, pass pointing on left hand and mild dysdiadochokinesia. Material and Method Investigations: Brain MRI showed asymmetric multifocal pattern of signal abnormality in keeping with demyelination but no optic neuritis. CSF analysis revealed oligoclonal bands and normal IgG index. Results Differential Diagnosis: Her prior diagnosis of acute disseminated encephalomyelitis (ADEM) was revised to early onset multiple sclerosis. Another possible cause which was ruled out was neurosarcoidosis. ***** Treatment: Interferon beta-1a (Rebif) therapy was commenced and was well tolerated apart from post-injection fatigue and flu-like symptoms. The regimen was changed to peginterferon beta-1a (Plergidy) six years after her initial diagnosis due to the patient's preference. Conclusions Outcome and prognosis: Since commencing interferon beta-1a therapy, the patient did not have a relapse of paralysis or unbalanced gait. She reported paraesthesia in her hands and feet. Repeat MRI scans of the brain did not reveal new lesions and showed improvement in prior lesions.