Przegl Lek. 2003;60 Suppl 1:1-4
Zgorzalewicz M, Michalowska-Wender G, Losy J, Wender M.
Katedra i Klinika Neurologii Wieku Rozwojowego AM 60-355 Poznan, ul. Przybyszewskiego 49
Multiple sclerosis (MS) in children and adolescents is a rare disease.
In such cases additional evidence from visual evoked potential (VEP) recordings, cerebrospinal fluid (CSF) analysis may be helpful in attaining security about the definite diagnosis of this disease.
The VEP assessment and the immunological investigation of CSF were performed in 42 patients with MS at the age of 4-22 years.
The diagnosis of this disease was based on the clinical and MR findings according to the recommended criteria by Mc Donald and al.
VEP recordings were performed with Multiliner equipment in accordance to the IFCN recommendations and CSF analysis including IgG index and the oligoclonal IgG bands by using isoelectric focusing.
Abnormal VEP typical of MS (delayed but with well-preserved wave form) was observed in 100% of MS patients with optic neuritis (ON).
Changes in VEP indicating clinically silent lesions in the visual pathway were found at the initial period of disease in 86% of patients in whom a diagnosis of clinically definite MS was established.
The increased IgG index, testifying the intrathecal IgG synthesis was found only in 52% cases, whereas the oligoclonal IgG bands were visible in 50% of patients.
This indicated the limited value of immunological studies of CSF in diagnosis of childhood and juvenile MS in contrast to VEP, which was the most helpful method especially in the detection of clinically silent lesions in the visual pathway.
Nevertheless, only close and careful evaluation of the neurological symptoms together with paraclinical investigations may be fundamental for early diagnosis of the disease in young patients.