Neuropediatrics 2011; 42 - P056
DOI: 10.1055/s-0031-1274028

Treatment of severe childhood Multiple Sclerosis with plasmapheresis

V Kraus 1, C Franke 2, P Strotmann 1, 3, C Makowski 1, S Burdach 1, B Hemmer 4
  • 1Kinderklinik München Schwabing – Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Schwabing, StKM GmbH und Klinikum Rechts der Isar (AÖR) der Technischen Universität München, München, Germany
  • 2Neurologische Praxis, München, Germany
  • 3KfH Nierenzentrum, München, Germany
  • 4Klinikum Rechts der Isar der Technischen Universität München, Neurologie, München, Germany

Introduction: In the past years the treatment options and recommendations for childhood MS have increased significantly. Especially an earlier use of immunomodulatory therapies and more invasive acute therapies have been recommended by experts.

Case report: We present the case of a 13 yo girl with relapsing remitting multiple sclerosis. She developed first neurological symptoms at the age of 8 years including facial nerve palsy and facial paresthesias. Following corticosteroid therapy there was complete remission of symptoms. At the age of 9 years she experienced a second relapse with the same symptoms and again complete remission after corticosteroid therapy. MRI of the brain showed disseminated white matter lesions and CSF was positive for oligoclonal bands. RRMS was diagnosed according to the Mc Donald criteria. She was started on IVIG and then IFN-beta 1a subcutaneously. Follow-up brain MRIs at the age of 11 and 13 years showed progression of the lesion load as well as contrast enhancement of some lesions. When she first presented to our department at the age of 13 years she acutely developed within a few days a severe episode of generalised ataxia, dysarthria, spasticity, bladder incontinence and paresthesias (EDSS 5.0). MRI showed a high lesion load, contrast enhancement and generalized brain atrophy. Steroids were only partially effective. Plasmapheresis was started on alternating days first in the pediatric intensive care unit, then on the pediatric nephrology ward. Reevaluation after 3 plasma-exchanges showed significant improvement of symptoms. Treatment was continued for 7 cycles (18,2 liters exchange volume). After 2 weeks the patient only showed minor truncal ataxia and minor fine motor skills disturbances (EDSS 2.5). MRI was free of contrast enhancing lesions.

Conclusion: Plasmapheresis was a safe and very effective treatment option in this child with a severe MS exacerbation. It should be considered as acute therapy in cases with insufficient response to high dose corticosteroid therapy.