engleski

Acute psychotic episode as manifestation of multiple sclerosis – case report

Objective: Multiple sclerosis (MS) is a demyelinating disease that shows variable clinical presentation. Some studies reported that 95% of adult patients with MS experience psychiatric symptoms and up to 1% of MS has psychiatric onset. Little data has been reported on psychotic symptoms occurring during the MS course or preceding the onset of MS in pediatric population. Methods: We report a case of a male pediatric patient with acute psychotic episode as first recognized manifestation of MS. Results: A 16- year-old boy was admitted to hospital under the diagnosis of epileptic seizure. He had episodes of staring, not responding and twitching his hands. During neurological examination emotional and behavioral disorders were observed, patient had attention deficit, inappropriate affect and speech disorder. EEG and brain CT did not show any abnormalities. Psychiatric and psychological evaluation were preformed and acute psychosis was diagnosed. Antipsychotic therapy with olanzapine and diazepam was started. There was no response to treatment so the patient was neurologically reevaluated and neurological deficits were observed. MRI of brain and cervical spine demonstrated multifocal demyelinating lesions separated in space and time and analysis of CSF confirmed the diagnosis of MS. Patient was treated with corticosteroids, intravenous immunoglobulins, plasma exchange therapy and disease-modifying therapy with teriflunomide was started on which he showed significant improvement. Conclusion: Every child with first psychotic episode or lack of response to standard treatments should be neurologically evaluated and MRI of brain should be considered.

Acute psychotic episode ; multiple sclerosis

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