Mental impairment common in children with MS

By Karla Gale

NEW YORK (Reuters Health) - Low IQ scores and cognitive problems (problems related to thinking and reasoning) are common in children and adolescents with multiple sclerosis (MS), according to an Italian study reported in the journal Neurology.

Approximately 5 percent of MS cases begin before age 18, note Dr. Maria Pia Amato, at the University of Florence, and her associates.

"The initial diagnosis of MS is more difficult in children than in adults," Amato told Reuters Health. Particularly before age 10, "symptoms may resemble those of acute encephalitis," with symptoms such as fever, alterations in mental state and level of consciousness. Breathing assistance with a mechanical respirator may be required and seizures and signs of brain involvement, which are rare in adults, may often occur in children.

In adolescents, she added, the onset of MS is more like that observed in young adults, with symptoms such as inflammation of the optic nerve, brain stem and cerebellar symptoms and sensory disturbances, usually without any change in mental state.

In either case, there is concern that an early onset of MS could have greater impact on cognitive function if normal neurodevelopment is stunted.

In the researchers' study, 63 MS patients and 57 healthy controls younger than 18 years of age underwent a neuropsychological test battery. MS began before age 10 years in 15 subjects.

In the MS group, the IQ scores were lower than in the placebo group, five MS children had an IQ below 70 vs. none of the placebo group. Fifteen of the MS group had an IQ between 70 and 89, vs. two children in the placebo group.

The only significant predictor of an IQ score less than 70 was younger age at onset.

Half of the MS patients failed at least two neuropsychological tests. Most affected were verbal and visuospatial memory, complex attention, and executive functions.

By interviewing parents, "we confirmed that the disease had a great functional impact and that, beyond the extent of physical disability, cognitive problems play a relevant role negatively affecting school, everyday, and social activities," the authors report.

In treating MS patients, physicians should always take into account the cognitive and psychosocial problems associated with MS and should include them in patient evaluations, Amato emphasized. In particular, global intellectual faculties and language problems need to be identified and dealt with, especially in children diagnosed with MS before the age of 10.

"I would like to highlight that treatment and support may help the subjects and the families to cope with their psychosocial difficulties," she added.

It is also possible that treatment of very young children may be more effective. "Therefore, early recognition of problems and intervention strategies, both rehabilitative and pharmacological, may lead to a better outcome."

SOURCE: Neurology, May 13, Neurology.