The Importance of Interdisciplinary Monitoring for Disease Progression in Pediatric MS

Background: Pediatric multiple sclerosis (MS) is an immune mediated disease of the central nervous system (CNS) that has been increasingly recognized. Clinical disease factors including clinical and radiological results vary substantially from adult MS. Pediatric MS patients present unique care management challenges due to the effect of a neurodegenerative disease on a developing brain. Previous literature highlighting the suboptimal correlation between clinical symptomology and MRI results has led to the recognition of a "clinical-radiographic paradox." Collaborative care through interdisciplinary teams is vital to the management of pediatric MS.

Objectives: We present an update on a longitudinal case study of a pediatric patient with MS including neuroimaging and neuropsychological findings.

Methods: Results from surveillance MRI scans and neuropsychological assessments completed for a patient with a pediatric diagnosis of MS over the span of 5 years are presented. These results are considered within the context of highly effective disease-modifying therapy.

Results: Surveillance MRI results revealed stable lesions, without evidence of disease progression. Despite stable neuroimaging results, data from repeat neuropsychological evaluations revealed declines on measures of working memory, processing speed, verbal fluency, and vocabulary knowledge between the first two neuropsychological evaluations. Weaknesses in aspects of academic fluency and executive functioning were also noted. These declines were seen within the context of stable intellectual abilities, visual-motor integration, verbal learning and memory, and attention skills.

Conclusions: This case highlights the complex neurodegenerative aspects of MS and the value of interdisciplinary monitoring for disease progression in pediatric MS. Commonly used T2-weighted sequences are insensitive to cortical demyelination and damage to gray matter structures, which may effect cognitive functioning in MS. Cognitive dysfunction has specific implications in the care management of pediatric patients with MS. For these reasons, routine neuropsychological assessments should be conducted to monitor functioning and assist with medical, educational, and psychosocial interventions.