Long-term MRI observations of childhood-onset relapsing-remitting multiplesclerosis

Purpose: Long-term MRI follow-up of childhood-onset relapsing-remitting mul tiple sclerosis (RRMS) was carried out in 4 cases. MRI findings were correl ated with clinical course and characteristic differences from adult-onset R RMS were elaborated. Methods: Two girls and one boy with true childhood-ons et, and one girl with juvenile-onset RRMS underwent 5-16 MRI examinations w ithin 6-8 years. The total number of lesions, the numbers of new, active, d isappearing and reappearing lesions, infratentorial and U-fibre lesions, "g iant" plaques and "black holes" were counted, Callosal atrophy and general brain atrophy were assessed, The findings were related to the physical stat us according to the Expanded Disability Status Scale (EDSS). Results and Co nclusions: Results showed that the primary differences in childhood-onset R RMS compared to adult-onset RRMS lie in the lack of, or slower development of irreversible changes ("black hole" formation, brain atrophy). Despite ca llosal atrophy and intensive U-fibre region involvement, school performance was unchanged. Regarding the frequency of "giant" lesions, an even more pr onounced white matter involvement was found in our children compared to adu lts. All children exhibited a rather "benign" disease course. A more intens ive remyelination, less severe neuronal loss, and higher functional brain p lasticity at younger ages may account for these differences.