Clinical and laboratory presentation and course of multiple sclerosis (MS) in 16 children are reported from the Department of Pediatric Neurology, Hacettepe University, Ankara, Turkey. The age of onset was 6 - 17 years (mean 11 yrs; 8 boys, 8 girls). Presenting symptoms and signs in order of frequency were cerebellar, pyramidal, optic neuritis, cranial nerve/brain stem signs, myelopathy, sensory, and increased intracranial pressure. CSF protein was normal in 11/12 patients tested, IgG index or oligoclonal bands were informative in 75%, evoked potentials abnormal in 70%, EEG abnormalities in 83%, MRI showed multiple plaques with increased density in T2-weighted images in 80%, and CT abnormalities in 45%. Moderate to severe disability after the first attack was seen in only 2 patients. [1]

COMMENT. MRI and CSF oligoclonal bands are the most helpful laboratory methods as adjuncts to the diagnosis of MS in children. Evoked potentials and CT are not of value in the differential diagnosis, and elevated CSF protein is more compatible with degenerative diseases other than MS. Acute disseminated encephalomyelitis and postinfectious encephalomyelitis resemble MS in the acute phase and diagnosis may only be made by follow up. At least 2 years interval was needed to exclude a relapsing MS course.

Diagnosis of multiple sclerosis in 5 childhood cases is reported from the Department of Pediatrics, La Sapienza University, and Department of Neurology, Tor Vergata University, Rome, Italy [2]. Initial symptoms in these patients were optic neuritis (2); paresthesia, dysmetria, dysgraphia; dizziness, weakness; and motor and sensory deficits. Time from first symptom to diagnosis varied from 20 days to 4 years. The MRI was most valuable in diagnosis, and elevation of CSF IgG was the best laboratory supportive finding. Neuropsychological tests may uncover cognitive dysfunction involving memory, language, and visual perception. The authors report an increasing number of pediatric cases of MS in the last 10 years.

Temporal variation in MS incidence was examined over the past 4 decades from 1950 to 1991 in More and Romsdal County, Norway, and reported from the University of Bergen, Norway [3]. The incidence rate by year of onset increased from 2.87/100,000 in 1950-54 to 5.57/100,000 in 1985-91. A two-fold increase in incidence of MS from 1961 to 1985 was reported previously by these authors. The increase was a general trend and was not explained by a change in age distribution. Could environmental factors and water and food pollutants be involved?

Depression and multiple sclerosis was evaluated in 221 patients examined at the Departments of Psychiatry and Medical Genetics, University of British Columbia, Vancouver, Canada [4]. Index cases had a 50% lifetime risk of depression. Data for the first-degree relatives did not support a genetic basis for depression among MS patients.