DEMYELINATING DISEASE OF SCHILDER TYPE IN 3 YOUNG SOUTH-AFRICAN CHILDREN - DRAMATIC RESPONSE TO CORTICOSTEROIDS

Three young children with the Schilder variant of multiple sclerosis w ere seen within a 3-year period at our hospital. The diagnosis was mad e on the basis of the typical (but not pathognomonic) clinical and mag netic resonance imaging (MRI) findings after eliminating other demyeli nating and post-infectious disorders of the central nervous system. Al l three patients were treated with prednisone (2 mg/kg/day), which res ulted in complete recovery in one patient and mild and moderate residu al hemiparesis in the two other patients, respectively. Corticosteroid therapy was continued until the patients' neurologic condition normal ized or no further clinical improvement occurred. No relapses were see n after discontinuation of corticosteroid treatment. Computed tomograp hic (CT) scan and MRI findings after completion of corticosteroid ther apy were equally dramatic and corresponded with the clinical improveme nt. A strongly positive tuberculin skin test and a positive history of contact with adult tuberculosis in two of our patients raise the poss ibility of a connection between tuberculosis and Schilder's disease.