Parker Nguyen, MD
Resident Physician
NewYork-Presbyterian
New York, New York, United States
Michelle Cho, MD
Resident Physician
New York Medical College
new york, New York, United States
Danielle Carey, DO
Resident Physician
NewYork-Presbyterian
New York, New York, United States
Amy Tenaglia, MD
Attending Physician
NewYork-Presbyterian
White Plains, New York, United States
Sydney Doman, BS, MS
Medical Student
Emory University School of Medicine
Atlanta, Georgia, United States
Xiaofang Wei, MD
Attending Physician
Blythedale Children's Hospital
Valhalla, New York, United States
Pediatric Multiple Sclerosis (PMS)
A fourteen-year-old Hispanic male with no past medical history presented to our pediatric facility for acute inpatient rehabilitation (AIR). Upon admission to outside hospital, patient reported sudden-onset right upper and lower extremity (RUE/RLE) weakness and paresthesia for three weeks. Patient reported two similar events three months (RUE numbness for one week) and one year (RUE/RLE for three weeks) prior to admission with complete remission between episodes. Initial physical examination showed right facial droop, right hemiparesis, and decreased sensation on the right. MRI brain with/without contrast (T2 sequence) showed white matter abnormalities involving left corpus callosum with left frontal enhancement and “Dawson’s fingers,” consistent with multiple sclerosis. CSF positive for oligoclonal IgG bands. Patient was evaluated by neurology and recommended repeat MRI for suspected pediatric multiple sclerosis (PMS) and discharge to AIR.
PMS has a female predominance after age 12 years and is seen mostly in Caucasians. The incidence of PMS in non-Caucasian male patients may be under-reported. Prior to AIR, patient was treated for acute PMS flare with IV methylprednisolone and vitamin D supplementation. Patient presented to AIR with mild right spastic hemiplegia, neuropathic pain, and slurred speech with subsequent impairments in ambulation, strength, balance, and endurance. He required supervision with a rolling walker for ambulation. Patient underwent intensive daily physical, occupational, and speech therapy. For spasticity and neuropathic pain, patient was started on gabapentin and aquatic therapy. After two weeks in AIR, patient demonstrated normal tone, normal speech, resolved neuropathic pain, improved right-sided weakness and progressed to ambulating 150 feet independently. Patient was recommended to continue outpatient therapy services for strength, gait, and endurance training.
AIR can be beneficial for PMS. Further studies of the rehabilitation for PMS are warranted, especially in under-reported populations as demonstrated in this case.
