Neuropediatrics 2011; 42 - P054
DOI: 10.1055/s-0031-1274026

Ongoing improvement in mobility, activity and cognition of a teenage girl with pediatric multiple sclerosis after 3 years of natalizumab treatment – a case report

K Lengnick 1, P Waibel 2, U Heiniger 3, H Spescha 4, M Käppeli 5, M Weissert 1
  • 1Ostschweizer Kinderspital, Neuropädiatrie, St. Gallen, Switzerland
  • 2Ostschweizer Kinderspital, Radiologie, St. Gallen, Switzerland
  • 3Ostschweizer Kinderspital, Neuropsychologie, St. Gallen, Switzerland
  • 4Kinderarzt, Chur, Switzerland
  • 5Kinder- und Jugendpsychiaterin, Chur, Switzerland

MS is a chronic inflammatory demyelinating disorder of the central nervous system. Childhood onset occurs in about 5%. Frequently the initial course of the disease is relapsing-remitting (RRMS) with a high relapse rate but the prospect of complete remission. Natalizumab has been recommended for the treatment of RRMS in adults with a high disease activity and poor response to other immunmodulatory therapies by showing a strong effect on physical and cognitive impairment, disease activity and quality of life. Similar experience has been described in recent reports using natalizumab in children. However observation period mainly in children is rather short and the risk of PML rise with long-term treatment.

We report a girl starting MS the age of 13, with a high relapsing rate and an increasing disability progression in spite of several therapeutic trial including steroids, IFNβ, IVIG and plasmapharesis. MRI detected increasing inflammatory activity. Therefore we attempt a treatment with Natalizumab 300mg i.v. every 4 weeks and find a suppression of clinical and radiological disease activity as well as a significant improvement of quality of life and regression of fatigue. The EDSS decreased from 7 to 1.5 and kept stabilized for now 1 1/2 years. The neuropsychological testing revealed slightly ameliorated cognitive potential with some deficits in the frontal lobe cortex. After a long time of impairment she now accomplish a nearly unimpaired school formation.

Natalizumab treatment is effective and well tolerated in our patient with RRMS with significant disability who poorly responded to several therapeutic trials. It not only stabilized the course of the disease but improved mobility, activity and emotional stability over a long observation period. Cognitive difficulties concerning to complex frontal brain dysfunction could be due to concurrently appearance of inflammation and ongoing frontal myelination in puberty. In view of the improvement of our patient potential for remyelination in childhood RRMS could be hypothesized and should be assessed in further studies.