MULTIPLE SCLEROSIS IN EARLY CHILDHOOD: CASE REPORT
ResumoIntroduction: Multiple sclerosis (MS) is an autoimmune and chronic disease that affects the Central Nervous System (CNS) that is composed of inflammation phase and degeneration phase. The symptoms could happen in different ways and it depends where the trauma happened in the CNS. This disease mainly affects people between 20-40 years old, being rarer in the early childhood. The objective in this paper is report the case of MS in a 9-year-old child. Case description: A 9-year-old male patient from Maracaju (MS), was attended at HUMAP in Campo Grande (MS) on 08/27/2016 complaining about vomit during the past 4 days, associated with vertigo and abnormal gait. During the physical examination, he presented bilateral nystagmus, decomposition and dysmetria on the right side. He presented a history of right hand strength loss, associated with face drooping two weeks later which regressed after one day without medical treatment. Two months later he presented an episode of vertigo and peripheral vestibular disorders were discarded. The electrophoresis of cerebrospinal fluid proteins demonstrated oligoclonal bands with serum equivalents, and the magnetic resonance showed focal lesions of demyelinating nature attachments to the corpus callosum and infratentorial region. During the appointment performed on 08/31/2017 at HUMAP, the patient was asymptomatic and he started pulse therapy with methylprednisolon. The physical examination, demonstrated a bilateral nystagmus with change of direction and asymmetry of reflexes, these being worse on the left. The Expanded Disability Status Scale (EDSS) was 1,5. The treatment with interferon 22 mg, subcutaneously, 3x/week was introduced. Discussion: In MS patients with less than 10 years old is considered rare and the estimated prevalence is 1%. A female to male rate is 1.57:1 between 6 and 10 years old. The clinical presentation in children has a broad spectrum, motor manifestations are the most frequent and the cerebellar disorders are the rarest. Cognitive decline is reported to be faster in MS when compared to adults. Futhermore, we have difficulties to medicate children and to receive the medication for this age due to the absence of clinical trials and it is released just with legal proceeding in Brazil. Although EM in early childhood is a medical practice challenge, this report reinforces the importance of considering this diagnosis in the pediatric community, because the premature treatment provided can delay the progression of the disease and the appearance of sequelae.
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