Possible cerebral MS, how can you tell?

Posted by Ray on July 03, 1999 at 09:21:57
How rare is cerebral MS and what makes the dx?
        We have a teenage son who started out this Feb. with a balance problem and terrible fatigue, moved on to an intention tremor in his arm and tremor in one leg. By the third month, his short term memory began to go. Other symptoms have come and gone, like numbness in right thigh, muscle weakness, stuttering, a body jerk whenever he closes his eyes, LOTS more symptoms when over heated etc. But balance and memory problems stay.
       He doesn't know what day it is and when you tell him, he forgets in a second. If he falls down, he wonders how he got on the floor. The quadratic equation that he had just learned this school year is gone, and so are all the multiplication tables above 4. We just got him a Nintendo 64 yesterday and he set it up and played for an hour. I brought him his lunch and he had to turn away from the TV to eat. He said he was really happy but he didn't know why. I asked him if he had gotten anything new, he said he didn't think so. I turned him back to the TV and he was all surprised that we had a new Nintendo. This happened with a light weight wheel chair we got him a month ago and he is just now beginning to accept that it is his - it still surprises him sometimes.
    When he is at the doctor's office this doesn't show up a lot, they don't ask things that would trip him up. Since I made a video, for our Ped., he has set up an appointment with an adult nuro in our HMO who treats MS so I expect we might get somewhere soon, but all I read in books is " cerebral MS is rare" and they dismiss it. From what I understand, people with cognitive problems in MS know that they forget, so they write themselves notes. He doesn't KNOW he forgets. Can you give us some more information?
     There is no dx yet, just my research and a nurse and several others who has MS themselves think we are on the right track. There has only been a normal MRI that was done when balance was the only problem, an EEG with no electrical siezures, and a negative lyme titer. (There were only 9 cases of lyme in our Northwest  Metro area - 1 million pop.- in the last year so that was ruled out. Saw a Ped.Infectious Disease Specalist.) Are there other tests that should be done?
     Thankyou for your time.
         Ray
Posted by CCF Neuro[P] MD, RPS on July 03, 1999 at 12:21:29
Dear Ray:
MS is a clinical diagnosis, meaning that the tests that we do support our clinical assessment.  The symptoms of MS wax and wane and they are usually episodic in nature.  So, the symptoms are multiple and they happen multiple times (hence the part of the name of the disease, multiple).  The symptoms usually include muscle weakness, numbness, optic neurities, speech changes, etc.  Depending on the brain area effected, one or more of these symptoms happen.  Different MS patients have different areas of their brain affected, hence the variety of symptoms in each patient.  Usually, the areas of the brain affected most, are the periventricular white matter areas, cerebellum and temporal lobes.  However, this is variable.  So, if you son had is lesions in areas of the brain associated with cognitive function or memory, he would have these symptoms.
The usual presentation is in the 30s and 40s but there are varieties that occur in children and also teenagers.  In addition to the clinical signs, we usually look for changes in the spinal fluid (oligoclonal bands, IgG synthesis, Kappa Chains, myelin basic protein level) and also MRI (white matter lesions).  Usually, more females are affected with MS but many males also have the disease.  The males usually have the more difficult MS to control.  However, there are no absolutes in medicine.  We have seen most all varieties of MS in all age groups.
The earlier the diagnosis, the earlier the treatment.  I would press your pediatrician to have your son seen by the MS specialist.  Is there a family history of MS?  There are many good MS physicians in the Northwest, as I use to live there.  
There are also other diseases that can mimic the early stages of MS.  So, it is important to get your son worked up for these as well.
Sincerely,
CCF Neuro MD