From Blurred Vision into Clarity - Unveiling the Diagnosis of Adolescent Onset Multiple Sclerosis

Abstract

Adolescent-onset multiple sclerosis is uncommon and often poses diagnostic challenges due to overlap with other pediatric demyelinating disorders.^[1,2] We report a well-documented case of RRMS (Relapsing–Remitting Multiple Sclerosis) in a 15-year-old girl who initially presented with unilateral optic neuritis followed six months later by brainstem–cerebellar symptoms. MRI (Magnetic Resonance Imaging) demonstrated multifocal supratentorial and infratentorialT2/FLAIR hyperintense lesions involving the brain and spinal cord, and CSF (Cerebrospinal Fluid) analysis showed positive oligoclonal bands. The diagnosis of RRMS was established using the 2017 McDonald criteria,^[3] allowing early initiation of DMT (Disease Modifying Therapy) with interferon beta 1a after treatment of the acute relapse with intravenous methylprednisolone. This case highlights the educational value of timely recognition of adolescent-onset MS, application of the revised diagnostic criteria, and the importance of early DMT initiation in a resource conscious setting.

Multiple sclerosis is a chronic immune mediated demyelinating disease of the central nervous system, predominantly affecting young adults.^[1,4] Pediatric-onset MS accounts for approximately 3–5% of all MS cases, with a substantial proportion presenting during adolescence rather than early childhood.^[2,4,5] Compared with adult-onset disease, pediatric and adolescent MS is characterized by higher relapse rates, more inflammatory MRI lesions, and potential long-term cognitive and psychosocial consequences.^[2,6] Early diagnosis is therefore critical. The 2017 revision of the McDonald criteria, including the use of CSF specific oligoclonal bands to demonstrate dissemination in time, has facilitated earlier and more confident diagnosis even after limited clinical events.^[3] We present an educational case of adolescent-onset RRMS illustrating these principles.