Cognitve impairment as a leading symptom in juvenile MS – two case reports -

MS affects various aspects of cognitive functioning, including attention, information processing, processing speed, short- and long-term memory in adults. However, this has not been consequently investigated in children with MS so far.

We report the clinical and cognitive course of two girls with MS, who presented with severe deficits in short-term and long-term memory.

General intelligence (K-TIM, CFT 20-R, HAWIK), attention (D2) information processing (VMLT) were performed at diagnosis and after 1 year. Both patients attended high school and had high marks.

At diagnosis of the disease both patients demonstrated beside motor symptoms severe deficits in short-term and long-term memory.

In patient 1 a significant decrement of general intelligence (K-TIM; general intelligence: 79, mean=100, SD15), difficulties in information processing and attention were detected already at diagnosis. After one year of treatment general intelligence did not increase significantly (CFT 20-R: 89) although there were no more clinical symptoms and new lesions in the brain or the cord. School problems became evident.

Patient 2 demonstrated with severe motor deficits and severe deficits in short-term and long-term memory. Testing general intelligence exhibited a normal value (104), which was within the normal range. There was no deficit in information processing but attention was affected. After one year of treatment with natalizumab no further symptoms and brain lesions occured and testing cognitive function did not show significant changes. Attention was within normal range. The patient is within the school leaving examination.

These two case reports demonstrate the importance of evaluation of cognitive function in patients with juvenile MS at diagnosis as cognitive dysfunctions may disrupt school everyday activities.