General Topics

Things to know about Multiple Sclerosis in Children | Neurology

What is multiple sclerosis in children?

Multiple Sclerosis in Children is a disorder of the central nervous system. This means that it affects the brain and spinal cord. It is an autoimmune disease as well as inflammatory – meaning that white blood cells, which protect against infection, enter the nervous system, and cause damage. The damage occurs because the myelin sheath, the protective covering of nerves, is stripped of antibodies produced by the immune system. (This is called demyelination). Multiple sclerosis is a long-term disease that can happen to anyone.

Multiple sclerosis begins in children or teenagers. About 98% have relapsing and migratory MS, versus 84% ​​of adults with MS. This means that symptoms come and go (relapse and remission). When symptoms disappear, the disease can still progress. This condition may also be called pediatric multiple sclerosis (POMS), early MS, or juvenile MS. Relapses seem to occur more often in children and teens. This group appears to recover from neurological disability more quickly but is at increased risk of cognitive difficulties that can affect schoolwork.

Symptoms of multiple sclerosis in children

MS symptoms depend on which nerves are affected. Because myelin damage is intermittent and can affect any part of the central nervous system, symptoms of MS are unpredictable and vary from person to person. In children, Multiple sclerosis is often the relapsing and dormant type. This means that the disease alternates between relapses, in which a person appears new symptoms, and calm, where there are only mild or no symptoms.

Attacks can last from days to weeks, and remission can last for months or years. Ultimately, the disease can progress to permanent disability. Most symptoms of multiple sclerosis in children are the same as in adults, include:

  • Weakness
  • Tingling and numbness
  • Eye problems, including vision loss, pain with eye movement, and double vision
  • Balance problems
  • Difficulty walking
  • Shivering
  • Spasticity (constant muscle contraction)
  • Problems with bowel and bladder control
  • Unclear

Symptoms such as weakness, numbness, tingling, and vision loss usually occur on one side of the body at a time. Mood disorders occur more frequently in children with MS. Depression is the most common, occurring in about 27 per cent of children with MS. Other frequent causes include:

  • Anxiety
  • Bipolar depression
  • Adjustment disorder
  • Panic disorder

Almost 30 per cent of children with multiple sclerosis have a cognitive impairment or problem with their thinking. Include the most affected activities:

  • Memory
  • Information processing
  • Executive functions like planning, organizing, and decision-making
  • Attention span
  • Speed and coordination performing tasks

Some symptoms appear more frequently in children but rarely in adults. These symptoms:

  • Seizures
  • Lethargy

Causes of multiple sclerosis in children

The cause of multiple sclerosis in children (and adults) is unknown. It is not contagious, and there is nothing that can be done to prevent it. However, there are several things that appear to increase your risk of developing it:

  • Genetics/family history: MS is not inherited from the parents, but if a child has certain sets of genes or a parent or sibling has MS, they are more likely to develop it.
  • Exposure to the Epstein-Barr virus: This virus may act as a trigger that releases MS in children exposed to it. However, many children are exposed to the virus and do not develop MS.
  • Low levels of vitamin D: MS is found more often in people in northern climates where there is less sunlight than around the equator. Our bodies need sunlight to produce vitamin D, so people in northern climates tend to have lower levels of vitamin D. Researchers believe this may imply a link between multiple sclerosis and low vitamin D. Additionally, low vitamin D levels increase the risk of relapse.
  • Exposure to smoking: Cigarette smoke, both direct use and passive exposure, has been shown to increase the risk of developing multiple sclerosis.

Evaluation and diagnosis of multiple sclerosis in children

Children who have been diagnosed with MS have a type called relapsing multiple sclerosis. This type of multiple sclerosis in children is characterized by recurrent episodes that cause new or worsening neurological symptoms, followed by periods without new symptoms, called remissions.

At the time of the first attack, it is not always clear whether the diagnosis of MS is appropriate because the relapsing disease has not yet occurred. New relapses or attacks will confirm your child’s diagnosis and provide insight to help their doctors better manage their care.

There is no single diagnostic test for MS. In most cases, MS is diagnosed in a combination of ways. Your child’s health care provider will take a thorough medical history and order tests that may include:

  • Neurological examination
  • Magnetic resonance imaging to check for lesions in the brain, spinal cord, or optic nerves
  • Lumbar puncture to check the cerebrospinal fluid for antibodies and proteins associated with multiple sclerosis

In some patients, the first MRI scan shows multiple lesions so closely aligned with MS that multiple sclerosis in children can be diagnosed after only one clinical attack. While not common, an early diagnosis can provide an important opportunity for early treatment.

Treatment of multiple sclerosis in children

Although there is no cure for multiple sclerosis in children, there are treatments aimed at reducing new lesions and relapses and slowing the progression of the disease:

  • Steroids can reduce inflammation and reduce the length and severity of relapses.
  • Plasma exchange, which removes antibodies that attack myelin, may be used to treat relapse if steroids do not work or are not tolerated.

Certain symptoms may be treated with other medicines to improve the quality of life. Physical, occupational and speech therapy can also be helpful for children with multiple sclerosis.

Follow-up care

Close follow-up of multiple sclerosis in children is vital to long-term outcomes, and this is provided at the CHOP Children’s Clinic with Multiple Sclerosis and Inflammatory Neurological Disorders. We closely follow children for evidence of relapse, and to monitor drug efficacy. Follow-up MRI studies will also be required on a regular basis, and we will personally review these images during clinic visits.

long-term outlook

Multiple sclerosis in children is a chronic condition that must be dealt with throughout life. The course of the disease is difficult to predict and varies from person to person. Some have long periods of remission while others have frequent seizures.


How serious is a spinal cord injury? | Neurology

What is spinal cord injury?

A spinal cord injury – harm to any aspect of the spinal cord or the nerves toward the finish of the spinal canal (cauda equina) – frequently causes lasting changes in quality, sensation, and other body capacities underneath the site of the injury.

If you have recently had a spinal cord injury, it may seem like every aspect of your life has been affected. You may feel the effects of your injury mentally, emotionally, and socially.

Numerous researchers are hopeful that propels in the examination will some time or another make fix of spinal cord injuries conceivable. The examination considers are in progress around the world. Then, medicines and recovery permit numerous individuals with SCI to lead gainful and autonomous lives.

Symptoms of spinal cord injury

Some of the symptoms of a spinal cord injury may include:

  • Problems with walking
  • Loss of bladder or bowel control
  • Inability to move arms or legs
  • Feeling of numbness or tingling in the extremities
  • Unconsciousness
  • Headache
  • Pressure, Pain, and stiffness in the back or neck
  • Signs of shock
  • Abnormal head position

What are the causes of spinal cord injury?

The most widely recognized reason for a spinal cord injury is trauma. Almost half of the injuries are caused by car accidents. Other types of trauma include:

  • Falls from heights,
  • Violence (stab wounds or gunshot wounds to the spine), and
  • Sports injuries (diving, football, rugby, equestrian, etc.).

Spinal cord injury can also be caused by cord compression due to a tumor, infection, or inflammation. Some patients have a smaller than normal spinal canal (called spinal stenosis) and are at higher risk of spinal cord injury.

All tissues of the body, including the spinal cord, require a good supply of blood to deliver oxygen and other nutrients. Failure of this blood to reach the spinal cord can result in a spinal cord injury. This can be caused by an aneurysm (distended blood vessel), compression of a blood vessel, or prolonged low blood pressure.

How are spinal cord injuries diagnosed?

The emergency room doctor will test the individual to see if there is any movement or sensation at or below the injury level. Methods for assessing autonomic function have also been developed (American Spinal Injury Association, or ASIA, Autonomic Criteria Classification). Include emergency medical examinations for a spinal cord injury:

  • Magnetic resonance imaging (MRI), which uses computer-generated radio waves and a strong magnetic field to produce detailed, 3D images of body structures, including tissues, organs, bones, and nerves. It can document brain and spinal injuries from injuries, as well as help, diagnose brain and spinal cord tumors, herniated discs, irregular blood vessels (blood vessels), bleeding and infections that may put pressure on the spine and spinal cord, and injury to the ligaments that support the cervical spine.
  • A computerized tomography (CT) scan provides fast, clear 2D X-ray images of organs, bones, and tissues. A CT scan of the nerves is used to view the brain and spine. CT scanning is excellent at detecting bone fractures, bleeding, and spinal stenosis (narrowing of the spinal canal), but CT scanning has less ability to image the spinal cord or identify ligament injury associated with an unstable spine compared to MRI.
  • X-rays (which show the levels of bone over the bones) of a person’s chest and skull are often taken as part of a neurological examination. X-rays can be used to see most parts of the body, such as a joint or a major organ system. In conventional x-rays, a focused batch of low-dose ionizing radiation is passed through the body onto a photographic plate. Since calcium in the bones absorbs X-rays more easily than soft tissues or muscles, the bone structure appears white on the film. Spinal misalignment or fracture can be seen within minutes. X-rays are taken in different positions of the neck (i.e. displays of flexion and extension) to detect instability of the cervical spine. Tissue lumps such as injured ligaments or disc bulging cannot be seen on conventional X-rays.


At first, the changes in the way your body works can be massive. However, your rehabilitation team will help you develop the tools you need to deal with the changes caused by a spinal cord injury, as well as recommend equipment and resources to enhance the quality of life and independence. Often affected areas include:

  • Bladder control: Your bladder will keep on putting away pee from your kidneys. However, your brain may not be able to control your bladder as well due to an injury to the message carrier (spinal cord).

Changes in bladder control increase the risk of developing a urinary tract infection. The changes may also lead to kidney infections and kidney or bladder stones. During the restoration, you’ll learn new strategies to help void your bladder.

  • Bowel control: Although your stomach and intestines function a lot as they did before the injury, the control of your bowel movements often changes. A diet rich in fiber may help regulate your bowel movement, and you’ll learn techniques to improve bowel function during rehab.
  • Skin sensation: Below the nerve level of your injury, you may have lost part or all of the sensation of the skin. Therefore, your skin cannot send a message to your mind when it is hit by certain things like prolonged stress, heat, or cold.

This may make you more likely to develop pressure sores, but changing positions frequently – with help, if needed – can help prevent these sores. You will learn proper skin care during rehabilitation, which can help you avoid these problems.

  • Control of blood circulation: A spinal cord injury may cause circulatory problems ranging from low blood pressure when elevated (orthostatic hypotension) to swelling of your limbs. These changes in blood circulation may also increase the risk of blood clots, such as deep vein thrombosis or a pulmonary embolus.

Another problem with circulatory control is potentially life-threatening high blood pressure (autonomic hyperreflexia). Your rehabilitation team will teach you how to treat these issues if they affect you.

  • Respiratory system: Your injury may make breathing and coughing worse if the stomach and chest muscles are affected. This includes your diaphragm and the muscles of your chest wall and abdomen.

The level of nerve injury will determine the type of breathing problems you may have. If you have an injury to the cervical and thoracic spinal cord, you may be at increased risk of developing pneumonia or other lung problems. Medicines and therapy can help prevent and treat these problems.

  • Muscle strength: Some people with spinal cord injuries experience one of two types of muscle tension problems: uncontrolled tension or movement in muscles (spasticity) or soft and limp muscles that lack muscle tension (relaxation).
  • Fitness and wellness: Weight reduction and muscle atrophy are regular not long after a spinal cord injury. Limited mobility can lead to a more sedentary lifestyle, which puts you at risk of obesity, cardiovascular disease, and diabetes.

A dietitian can help you eat a nutritious diet to maintain an adequate weight. Physical and occupational therapists can assist you in building up a wellness and exercise program.

  • Sexual health: Sexual life, fertility, and sexual function may be affected by a spinal cord injury. Men may notice changes in erection and ejaculation. Women may notice changes in lubrication. Doctors who specialize in urology or fertility surgery can offer options for sexual performance and fertility.

Some people experience pain, such as muscle or joint pain, due to the overuse of certain muscle groups. Nerve pain can occur after a spinal cord injury, especially in a person with an incomplete injury. Dealing with all the changes that a spinal cord injury brings and living with pain causes some people to become depressed.

Spinal cord injury treatment

Treatment for SCI begins before the patient is admitted to the hospital. Paramedics or other EMS personnel carefully stabilize the entire spine at the scene of the accident. In the emergency department, this freeze continues while more serious, life-threatening problems are identified and addressed. If the patient must undergo emergency surgery due to trauma to the abdomen, chest, or other areas, the stability of the spine and alignment of the spine is maintained during the operation.

Non-Surgical Treatments

If the patient has an SCI, they are usually admitted to the intensive care unit (ICU). For some cervical spine wounds, footing might be shown to help bring the spine into an appropriate arrangement. Standard intensive care unit care, including maintaining stable blood pressure, monitoring cardiovascular function, ensuring adequate ventilation and lung function, prevention and prompt treatment of infection, and other complications, is basic so SCI patients can accomplish the most ideal result.


Sometimes the surgeon may want to take the patient to the operating room immediately if the spinal cord appears to be compressed by a herniated disc, blood clot, or other lesions. This is generally regular in patients with deficient SCI or with reformist neurological decay. Regardless of whether medical procedure can’t invert the harm to the spinal cord, medical procedure might be expected to balance out the spine to forestall future agony or disfigurement. The surgeon will decide which procedure will provide the most benefit to the patient.


Neurologically, people with complete quadriplegia have a high risk of developing secondary medical complications, including pneumonia, pressure ulcers, and deep venous thrombosis. Pressure ulcers are the most noticeable complication, starting with 15% during the first year after infection and increasing steadily thereafter.

Restoration of function depends on the severity of the initial injury. Unfortunately, those with a complete SCI are unlikely to regain function below the level of the injury however, if there is some degree of improvement, it usually establishes itself within the first few days after the accident.

Incomplete injuries as a rule give some level of progress after some time, however, this differs from the kind of injury. Although full recovery may be unlikely in most cases, some patients may be able to get better at least enough to move and control bowel and bladder function.

Once the patient’s condition has stabilized, care, and treatment focus on supportive care and rehabilitation. All family members or specially trained nurses or aides may provide supportive care. This care may include helping the patient to bathe, dress, and change positions to prevent bedsores and other forms of assistance.

Restoration frequently incorporates physical therapy, occupational therapy treatment, and guiding for enthusiastic help. Services may be provided initially while the patient is hospitalized. After admission to the hospital, some patients are admitted to the rehab facility. Other patients may pursue rehabilitation on an outpatient basis and/or at home.

What’s the long-term outlook?

A few people lead full and beneficial carries on with after a spinal cord injury. However, there are potentially dire effects of spinal cord injury. The vast majority of people will need assistive devices such as walkers or wheelchairs to deal with motion loss, and some may be paralyzed from the neck down.

You may need help with activities of daily living and learn to perform tasks differently. Pressure sores and urinary tract infections are normal intricacies. You may also expect to undergo intensive spinal cord injury rehabilitation treatment.

Risk factors

Although a spinal cord injury is usually the result of an accident and can happen to anyone, some factors may put you at a higher risk for a spinal cord injury, including:

  • To be a male: Spinal cord injuries influence an unbalanced number of men. Actually, females represent just about 20% of horrible spinal cord injuries.
  • Being between 16 and 30 years old: You are more likely to suffer a traumatic spinal cord injury if you are between the ages of 16 and 30. The normal age at the hour of injury is 43 years.
  • Being over the age of 65: Falls cause most injuries in the elderly.
  • Engaging in risky behavior: Diving in shallow water or exercising without wearing the appropriate safety equipment or taking appropriate precautions can result in spinal cord injuries. Car collisions are the main source of spinal cord injury for individuals younger than 65.
  • Having a bone or joint disorder: A relatively minor injury can cause a spinal cord injury if you have another disorder that affects your bones or joints, such as osteoarthritis or osteoporosis.

How can I prevent spinal cord injuries?

Since spinal cord injuries are often the result of unexpected events, the best thing you can do is to reduce your risk. Some risk reduction measures include:

  • Always wear a seat belt while you are in the car
  • Wear appropriate protective clothing while playing sports
  • Never dive into water unless you check it first to make sure it is deep enough and free of rocks

About Huntington’s disease and Treatments of HD | Neurology

What is Huntington’s disease?

Huntington’s disease is an uncommon hereditary ailment that causes the reformist breakdown (degeneration) of nerve cells in the cerebrum. Huntington’s disease has a significant impact on a person’s functional abilities and usually results in disturbances in movement, thinking (perception), and mental disorders.

Huntington’s disease side effects can show up whenever, however, they regularly first show up when individuals are in their 30s or 40s. If the condition develops before the age of 20, it is called Young Huntington’s disease. When Huntington’s disease develops early, symptoms are somewhat different and the disease may progress faster.

Medicines are available to help manage the symptoms of Huntington’s disease. But treatments cannot prevent the physical, mental, and behavioral deterioration associated with the condition.

Symptoms of Huntington’s disease

Symptoms usually begin around the age of 30 to 50 years, but they can start much earlier or much later.

Symptoms may include Huntington’s disease:

  • Difficulty with concentration and memory
  • Depression
  • Tripping and Breaching
  • Involuntary jerking or restless movements of the limbs and body
  • Mood swings and personality changes
  • Problems with swallowing, speaking and breathing
  • Difficulty moving

Full-time nursing care is needed in the later stages of the condition. It is usually fatal about 15 to 20 years after symptoms begin.

Causes of Huntington’s disease

A single gene defect causes Huntington’s disease. It is considered an autosomal dominant disorder. This means that one copy of the abnormal gene is sufficient to cause the disease. If one of your parents had this genetic defect, you have a 50 percent chance of inheriting it. You can likewise give it to your children.

The genetic mutation responsible for Huntington’s disease differs from many of the other mutations. There is no substitute or missing section in the gene. Instead, there is a transcription error. A region within a gene is replicated multiple times. The number of duplicates tends to increase with each generation.

In general, symptoms of Huntington’s disease appear early in people who have a higher number of recurrences. The disease also progresses faster as more recurrences accumulate.


Not being able to do things that were easy before can lead to frustration and depression. Weight loss can worsen symptoms and weaken a patient’s immune system, making them more vulnerable to infections and other complications. HD itself is not usually fatal, but it can be choking, pneumonia, or other infection. At all stages, it is important to adjust the patient’s diet to ensure adequate food intake.

How is Huntington’s disease diagnosed?

Family history plays a major role in diagnosing Huntington’s disease. However, a variety of clinical and laboratory tests may be done to help diagnose the problem.

Neurological tests

The neurologist will perform tests to verify:

  • Reactions
  • Coordinate
  • Balance
  • Muscle strength
  • Energy
  • Sense of touch
  • He heard
  • Vision

Brain function and imaging tests

If you’ve had epileptic seizures, you may need an electroencephalogram (EEG). This test gauges the electrical action in your mind.

Brain imaging tests may also be used to detect physical changes in your brain.

  • MRI scans use magnetic fields to record images of the brain with a high level of detail.
  • Computerized tomography (CT) scans combine several X-rays to produce a cross-section of your brain.

Psychiatric tests

Your doctor may ask you to undergo a psychological evaluation. This evaluation checks your coping skills, emotional state, and behavior patterns. The psychiatrist will likewise search for indications of impaired thinking.

You may be tested for drug use to see if the drugs could explain your symptoms.

Genetic testing

If you have multiple symptoms associated with Huntington’s disease, your doctor may recommend a genetic test. A genetic test can definitively diagnose this condition.

Genetic testing may also help you determine whether or not you have children. A few people with Huntington’s disease would prefer not to hazard passing the blemished quality onto the people to come.

Huntington’s disease treatment

HD is currently incurable. There is no treatment that can reverse or slow its progress. However, some symptoms can be controlled with medications and treatments.


Tetrabenazine (Xenazine) is approved by the Food and Drug Administration (FDA) to treat the jerky or involuntary movements or dance associated with HD.

Side effects consider depression & suicidal thoughts or actions.

Symptoms include:

  • Feeling sad and crying
  • Loss of enthusiasm for friends and previously enjoyable activities
  • Sleeping much than expected and feeling tired
  • Feelings of guilt or insignificance
  • Feeling more nervous, angry, or anxious than before
  • Eat less than usual, possibly with weight loss
  • Difficulty concentrating
  • Thinking about harming oneself or ending one’s life

Any of these symptoms or any other mood changes should be reported to the doctor immediately. Anyone with a diagnosis of depression, especially with suicidal thoughts, should not use tetrabenazine.

They may include drugs that control movements, seizures, and hallucinations:

  • Clonazepam (Klonopin)
  • Clozapine (Clorazil)
  • Haloperidol

These medications may cause sedation as well as stiffness and stiffness.

For depression and some of the obsessive-compulsive features that can appear with HD, a doctor may prescribe:

  • Fluoxetine (Prozac, Sarafem)
  • Nortriptyline (Pamelor)
  • Sertraline (Zoloft)

Lithium might help treat intense emotions and mood swings.

Speech therapy

Speech therapy can help patients find ways to express words and phrases and communicate more effectively.

Physical and occupational therapy

A physical therapist can help improve muscle strength and flexibility, leading to better balance and a reduced risk of falls.

An occupational therapist can help the patient develop strategies to deal with concentration and memory problems, as well as make the home safer.

What is the long-term outlook for Huntington’s disease?

There is no way to prevent this disease from progressing. The rate of progression varies for each person and depends on the number of genetic repeats present in your genes. A lower number normally implies that the infection will advance all the more gradually.

People with Huntington’s disease usually live 15 to 20 years after symptoms begin. The beginning stage structure by and large advances at a quicker rate. People may only live for 10 to 15 years after symptoms appear.

Causes of death include those with Huntington’s disease:

  • Infections, such as pneumonia
  • Suicide
  • Fall injuries
  • Complications of inability to swallow

Is Huntington’s disease Prevented?

People with a known family history of Huntington’s disease are understandably concerned about whether they might pass the Huntington gene to their children. These individuals may think about hereditary testing and family arranging choices.

If an at-risk parent is considering genetic testing, it may be helpful to meet with a genetic counselor. The genetic counselor will discuss the potential risks of a positive test result, which would indicate that the parent will develop the disease. Also, couples will need to make additional choices about having children or consider alternatives, such as prenatal testing for the gene or in vitro fertilization with donor sperm or eggs.

Another option for couples is IVF and preimplantation genetic diagnosis. In this process, eggs are removed from the ovary and fertilized with the father’s sperm in the laboratory. Embryos are tested for the presence of the Huntington gene, and only those that test negative for the Huntington gene are implanted in the mother’s womb.