Multiple sclerosis under the age of ten: the challenge of a rare diagnosis in a special population - a case series.

Introduction: Multiple sclerosis (MS) is a chronic inflammatory demyelinating and degenerative disease of the central nervous system which, when it begins before the age of 18, is defined as paediatric MS. Most common clinical presentations include long tract involvement, brainstem/cerebellum syndromes, optic neuritis and acute disseminated encephalomyelitis. Paediatric-onset MS typically has a more inflammatory-active course and a higher lesion burden in imaging studies, but an extensive post-relapse recovery, with a slower long-term disability progression. The first demyelinating clinical attack occurs before 10 years old in less than 1% of patients, and, in this special population, the condition has particularities in clinical presentation, differential diagnosis, diagnostic assessment, current treatment options and outcome. Clinical cases: We present the cases of four Caucasian children (2 girls) diagnosed with relapsing-remitting MS before the age of ten, with a mean age at the time of the first relapse of 7.4 ± 2.4 years. Clinical presentation included optic neuritis, myelitis, brainstem syndrome, and acute disseminated encephalomyelitis. Baseline MRI identified several lesions, frequently large and ill-defined. Two patients were included in clinical trials and two patients remain in clinical and imaging surveillance. Conclusion: Diagnosis of MS before the age of 10 years is rare, but it has significant long-term physical and cognitive consequences, as well as a substantial impact on the current and future quality of life of the child and family. Early and correct diagnosis is essential. Prospective, randomized, large cohort studies are needed to assess the efficacy and safety of disease-modifying treatments in children under the age of ten.

The migraine postdrome: Clinical characterization, influence of abortive treatment and impact in the quality of life.

OBJECTIVE: To determine the postdrome's prevalence and characterize its clinical manifestations, to assess the impact of these symptoms on the patients' activities of daily living, work activity and quality of life and to assess the factors that influence the postdrome's frequency and duration. METHODS: One hundred patients with migraine were screened about the occurrence of postdrome and its characteristics using a self-fulfilled questionnaire. RESULTS: Ninety-four patients reported between 1 and 23 postdrome symptoms (mean 8.0 ± 4.3 symptoms). The most reported symptoms were fatigue, difficulty with concentration and head discomfort. The frequency of the headache did not influence the frequency of the postdrome but correlated with the number of postdrome symptoms and the postdrome's duration. 82.8 % of patients reported an impact in quality of life. Most of the patients (77.4 %) did not report a difference in the duration of the postdrome when taking medication to relieve the migraine headache. Discomfort felt did not differ between patients prescribed with different abortive medication. Patients prescribed with NSAID reported more postdrome symptoms while patients prescribed with triptans identified a bigger impact in quality of life. CONCLUSION: Postdrome symptoms are frequent, diverse and cause significant disability. Abortive treatment directed to pain control is not efficient in postdrome symptoms. Understanding this phase may enhance our understanding of migraine and lead to better therapeutic approaches.