4-2007

.: Дата публікації 2009-07-14 :: Переглядів: 8 :: :.

---

Problems of diagnostics and prognosis of multiple sclerosis and encephalomyelitis in children
V.M. YEFIMENKO

Purpose – to study the peculiarities of diagnostics, course and prognosis of multiple sclerosis (MS) and encephalomyelitis in children.
Methods and subjects. The examination of 119 children aged from 6 month till 16 years was carried out. Children were divided into the following group according to nosology: 31 children with MS, 12 children with retrobulbar neuritis of the optic nerve (RNON), 30 children with the acute multiple encephalomyelitis (AME), 11 children with the diffusive encephalitis with MS syndrome, and 35 children with other diseases in which MS was excluded. The magnetic resonance imaging of cerebrum and spinal cord and the examination of evoked visual potentials were carried out.
Antibodies to viruses of influenza and enteroviruses were determined.
Results. Monosymptomatic onset of the MS was detected in 21 from 31 patients. The first symptoms were: RNON, ataxia, neuropathy of the facial nerve. In case of polysymptomatic onset, the movement impairments with RNON, sensitivity impairment and ataxia were observed. In the majority of cases the development of MS started during the first two years after the onset (84 %). Typical MRI changes under MS were detected in 7 patients, 2 patients had not specific changes of brain sheath. The rest patients didn’t have any changes on the early stages of MS. The evoked visual
potentials were changed in 19 patients from 20. The following clinical types of AME were differentiated: encephalomyelopolyradiculonevritis – 12 patients, diffusive encephalitis – 9, opticoencephalomyelatis – 4, diffusive myelitis – 2, AME with not complete transverse damage of spinal cord – 2, encephalopoyneuritis with damage of cranial nerves and ataxia – 1.
Conclusions. MS can occur and be diagnosed in children at the age under 4 years with its peak at the age of 12–13 years. Monosymptomatic onset has the prevalence on polysymptomatic one in children. The course of the disease is remitting. The evoked visual potentials are important for the diagnostic of onset and early stages of MS in children, but not for the differential diagnostic of MS accompanied by other diseases of CNS. The magnetic resonance imaging is the most informative methods for MS early stages diagnosing. In case of long$termed observation positive course of MS is observed in 2/3 children, and in 1/3 children it has aggressive course.