Advertisement

Pediatric Multiple Sclerosis

  • Lauren Krupp
  • Yashma Patel
  • Vikram Bhise
Chapter
Part of the Current Clinical Neurology book series (CCNEU)

Abstract

Pediatric multiple sclerosis (MS) has long been an under-recognized MS ­subgroup. Fortunately, the special diagnostic challenges, the clinical course, treatment, and special needs of this MS subgroup are receiving increased attention. Pediatric MS occurs in most of the world although the frequency varies. Differential diagnoses such as the distinction from acute disseminated encephalomyelitis (ADEM) differ from adults. The pathogenic mechanisms remain unclear with respect to pediatric MS. The strongest association of pediatric MS is with remote EBV infection, possibly reflecting heightened immune activation or reactivation of EBV. Certain clinical aspects of pediatric MS overlap with adults but there are often differences particularly in the younger children in clinical, radiologic, and laboratory manifestations. Unfortunately, there is a sizable proportion of children and adolescents who are very vulnerable to cognitive dysfunction in addition to other psychosocial stresses. The family unit is critically important in this age group and plays a different role than in adult MS. Management is complicated by the lack of clinical trials specific to children. Nonetheless, experience in evaluating and treating children has rapidly grown. The current review summarizes this experience.

Keywords

Optic neuritis Initial demyelinating event Cognition Fatigue Prognosis 

References

  1. 1.
    Duquette P, Murray TJ, Pleines J, et al. Multiple sclerosis in childhood: clinical profile in 125 patients. J Pediatr. 1987;111:359–63.PubMedGoogle Scholar
  2. 2.
    Boiko A, Vorobeychik G, Paty D, Devonshire V, Sadovnick D. Early onset multiple sclerosis: a longitudinal study. Neurology. 2002;59:1006–10.PubMedGoogle Scholar
  3. 3.
    Ghezzi A, Deplano V, Faroni J, et al. Multiple sclerosis in childhood: clinical features of 149 cases. Mult Scler. 1997;3:43–6.PubMedGoogle Scholar
  4. 4.
    Sindern E, Haas J, Stark E, Wurster U. Early onset MS under the age of 16: clinical and paraclinical features. Acta Neurol Scand. 1992;86:280–4.PubMedGoogle Scholar
  5. 5.
    Ruggieri M, Polizzi A, Pavone L, Grimaldi LM. Multiple sclerosis in children under 6 years of age. Neurology. 1999;53:478–84.PubMedGoogle Scholar
  6. 6.
    Renoux C, Vukusic S, Mikaeloff Y, et al. Natural history of multiple sclerosis with childhood onset. N Engl J Med. 2007;356:2603–13.PubMedGoogle Scholar
  7. 7.
    Simone IL, Carrara D, Tortorella C, et al. Course and prognosis in early-onset MS: comparison with adult-onset forms. Neurology. 2002;59:1922–8.PubMedGoogle Scholar
  8. 8.
    Chitnis T, Glanz B, Jaffin S, Healy B. Demographics of pediatric-onset multiple sclerosis in an MS center population from the Northeastern United States. Mult Scler. 2009;15:627–31.PubMedGoogle Scholar
  9. 9.
    Compston A. McAlpine’s multiple sclerosis. 3rd ed. London: Churchill Livingston; 1998.Google Scholar
  10. 10.
    Banwell B, Kennedy J, Sadovnick D, et al. Incidence of acquired demyelination of the CNS in Canadian children. Neurology. 2009;72:232–9.PubMedGoogle Scholar
  11. 11.
    Banwell B, Ghezzi A, Bar-Or A, Mikaeloff Y, Tardieu M. Multiple sclerosis in children: clinical diagnosis, therapeutic strategies, and future directions. Lancet Neurol. 2007;6:887–902.PubMedGoogle Scholar
  12. 12.
    Deryck O, Ketelaer P, Dubois B. Clinical characteristics and long term prognosis in early onset multiple sclerosis. J Neurol. 2006;252:720–3.Google Scholar
  13. 13.
    Boster AL, Endress CF, Hreha SA, Caon C, Perumal JS, Khan OA. Pediatric-onset multiple sclerosis in African-American black and European-origin white patients. Pediatr Neurol. 2009;40:31–3.PubMedGoogle Scholar
  14. 14.
    Krupp L. Racial and ethnic findings in pediatric MS: an update. Neurology. 2008;S70:A135.Google Scholar
  15. 15.
    Dale RC, de Sousa C, Chong WK, Cox TC, Harding B, Neville BG. Acute disseminated encephalomyelitis, multiphasic disseminated encephalomyelitis and multiple sclerosis in children. Brain. 2000;123(Pt 12):2407–22.PubMedGoogle Scholar
  16. 16.
    Neuteboom RF, Boon M, Catsman Berrevoets CE, et al. Prognostic factors after a first attack of inflammatory CNS demyelination in children. Neurology. 2008;71:967–73.PubMedGoogle Scholar
  17. 17.
    Mikaeloff Y, Suissa S, Vallee L, et al. First episode of acute CNS inflammatory demyelination in childhood: prognostic factors for multiple sclerosis and disability. J Pediatr. 2004;144:246–52.PubMedGoogle Scholar
  18. 18.
    Dale RC, Brilot F, Banwell B. Pediatric central nervous system inflammatory demyelination: acute disseminated encephalomyelitis, clinically isolated syndromes, neuromyelitis optica, and multiple sclerosis. Curr Opin Neurol. 2009;22:233–40.PubMedGoogle Scholar
  19. 19.
    Mikaeloff Y, Caridade G, Husson B, Suissa S, Tardieu M. Acute disseminated encephalomyelitis cohort study: prognostic factors for relapse. Eur J Paediatr Neurol. 2007;11:90–5.PubMedGoogle Scholar
  20. 20.
    Dale RC, Pillai SC. Early relapse risk after a first CNS inflammatory demyelination episode: examining international consensus definitions. Dev Med Child Neurol. 2007;49:887–93.PubMedGoogle Scholar
  21. 21.
    Bonhomme GR, Waldman AT, Balcer LJ, et al. Pediatric optic neuritis: brain MRI abnormalities and risk of multiple sclerosis. Neurology. 2009;72:881–5.PubMedGoogle Scholar
  22. 22.
    Wilejto M, Shroff M, Buncic JR, Kennedy J, Goia C, Banwell B. The clinical features, MRI findings, and outcome of optic neuritis in children. Neurology. 2006;67:258–62.PubMedGoogle Scholar
  23. 23.
    Lucchinetti CF, Kiers L, O’Duffy A, et al. Risk factors for developing multiple sclerosis after childhood optic neuritis. Neurology. 1997;49:1413–8.PubMedGoogle Scholar
  24. 24.
    Alper G, Wang L. Demyelinating optic neuritis in children. J Child Neurol. 2009;24:45–8.PubMedGoogle Scholar
  25. 25.
    McDonald WI, Compston A, Edan G, et al. Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol. 2001;50:121–7.PubMedGoogle Scholar
  26. 26.
    Mikaeloff Y, Adamsbaum C, Husson B, et al. MRI prognostic factors for relapse after acute CNS inflammatory demyelination in childhood. Brain. 2004;127:1942–7.PubMedGoogle Scholar
  27. 27.
    Callen DJ, Shroff MM, Branson HM, et al. MRI in the diagnosis of pediatric multiple sclerosis. Neurology. 2009;72:961–7.PubMedGoogle Scholar
  28. 28.
    Ozakbas S, Idiman E, Baklan B, Yulug B. Childhood and juvenile onset multiple sclerosis: clinical and paraclinical features. Brain Dev. 2003;25:233–6.PubMedGoogle Scholar
  29. 29.
    Ghezzi A, Pozzilli C, Liguori M, et al. Prospective study of multiple sclerosis with early onset. Mult Scler. 2002;8:115–8.PubMedGoogle Scholar
  30. 30.
    Gusev E, Boiko A, Bikova O, et al. The natural history of early onset multiple sclerosis: comparison of data from Moscow and Vancouver. Clin Neurol Neurosurg. 2002;104:203–7.PubMedGoogle Scholar
  31. 31.
    Banwell B, Krupp L, Kennedy J, et al. Clinical features and viral serologies in children with multiple sclerosis: a multinational observational study. Lancet Neurol. 2007;6:773–81.PubMedGoogle Scholar
  32. 32.
    Pohl D, Rostasy K, Treiber-Held S, Brockmann K, Gartner J, Hanefeld F. Pediatric multiple sclerosis: detection of clinically silent lesions by multimodal evoked potentials. J Pediatr. 2006;149:125–7.PubMedGoogle Scholar
  33. 33.
    Mikaeloff Y, Caridade G, Assi S, Suissa S, Tardieu M. Prognostic factors for early severity in a childhood multiple sclerosis cohort. Pediatrics. 2006;118:1133–9.PubMedGoogle Scholar
  34. 34.
    Tenembaum S, Chamoles N, Fejerman N. Acute disseminated encephalomyelitis: a long-term follow-up study of 84 pediatric patients. Neurology. 2002;59:1224–31.PubMedGoogle Scholar
  35. 35.
    Chabas D, Castillo-Trivino T, Mowry EM, Strober JB, Glenn OA, Waubant E. Vanishing MS T2-bright lesions before puberty: a distinct MRI phenotype? Neurology. 2008;71:1090–3.PubMedGoogle Scholar
  36. 36.
    Chabas D, Ness J, Belman A, et al. Younger children with pediatric MS have a distinct CSF inflammatory profile at disease onset. Neurology. 2010;74(5):399–405.PubMedGoogle Scholar
  37. 37.
    MacAllister WS, Krupp LB. Multiple sclerosis-related fatigue. Phys Med Rehabil Clin N Am. 2005;16:483–502.PubMedGoogle Scholar
  38. 38.
    Amato MP, Goretti B, Ghezzi A, et al. Cognitive and psychosocial features of childhood and juvenile MS. Neurology. 2008;70:1891–7.PubMedGoogle Scholar
  39. 39.
    MacAllister W, Milazzo M, Troxell RM, et al. Fatigue and quality of life in pediatric multiple sclerosis. Ann Neurol. 2006;60:S39.Google Scholar
  40. 40.
    MacAllister WS, Belman AL, Milazzo M, et al. Cognitive functioning in children and adolescents with multiple sclerosis. Neurology. 2005;64:1422–5.PubMedGoogle Scholar
  41. 41.
    Banwell BL, Anderson PE. The cognitive burden of multiple sclerosis in children. Neurology. 2005;64:891–4.PubMedGoogle Scholar
  42. 42.
    MacAllister WS, Christodoulou C, Milazzo M, Krupp LB. Longitudinal neuropsychological assessment in pediatric multiple sclerosis. Dev Neuropsychol. 2007;32:625–44.PubMedGoogle Scholar
  43. 43.
    Amato M. Cognitive and psychosocial features of childhood and juvenile multiple sclerosis: a reappraisal after 2 years. Neurology. 2009;3:A97.Google Scholar
  44. 44.
    Pohl D, Rostasy K, Gartner J, Hanefeld F. Treatment of early onset multiple sclerosis with subcutaneous interferon beta-1a. Neurology. 2005;64:888–90.PubMedGoogle Scholar
  45. 45.
    Ghezzi A, Amato MP, Capobianco M, et al. Disease-modifying drugs in childhood-juvenile multiple sclerosis: results of an Italian co-operative study. Mult Scler. 2005;11:420–4.PubMedGoogle Scholar
  46. 46.
    Tenembaum S, Chitnis T, Ness J, Hahn JS. Acute disseminated encephalomyelitis. Neurology. 2007;68:S23–36.PubMedGoogle Scholar
  47. 47.
    Wingerchuk DM, Lucchinetti CF. Comparative immunopathogenesis of acute disseminated encephalomyelitis, neuromyelitis optica, and multiple sclerosis. Curr Opin Neurol. 2007;20:343–50.PubMedGoogle Scholar
  48. 48.
    Filippi M, Rocca MA. MRI evidence for multiple sclerosis as a diffuse disease of the central nervous system. J Neurol. 2005;252 Suppl 5:v16–24.PubMedGoogle Scholar
  49. 49.
    Krupp LB, Banwell B, Tenembaum S. Consensus definitions proposed for ­pediatric multiple sclerosis and related disorders. Neurology. 2007;68:S7–12.PubMedGoogle Scholar
  50. 50.
    Brass SD, Caramanos Z, Santos C, Dilenge ME, Lapierre Y, Rosenblatt B. Multiple sclerosis vs acute disseminated encephalomyelitis in childhood. Pediatr Neurol. 2003;29:227–31.PubMedGoogle Scholar
  51. 51.
    Tenembaum S, Chitnis T, Ness J, Hahn JS, Group IPMS. Acute disseminated encephalomyelitis. Neurology. 2007;68:S23–36.PubMedGoogle Scholar
  52. 52.
    Callen DJ, Shroff MM, Branson HM, et al. Role of MRI in the differentiation of ADEM from MS in children. Neurology. 2009;72:968–73.PubMedGoogle Scholar
  53. 53.
    Hynson JL, Kornberg AJ, Coleman LT, Shield L, Harvey AS, Kean MJ. Clinical and neuroradiologic features of acute disseminated encephalomyelitis in children. Neurology. 2001;56:1308–12.PubMedGoogle Scholar
  54. 54.
    Banwell B, Tenembaum S, Lennon VA, et al. Neuromyelitis optica-IgG in ­childhood inflammatory demyelinating CNS disorders. Neurology. 2008;70:344–52.PubMedGoogle Scholar
  55. 55.
    Hahn CD, Shroff MM, Blaser SI, Banwell BL. MRI criteria for multiple sclerosis: evaluation in a pediatric cohort. Neurology. 2004;62:806–8.PubMedGoogle Scholar
  56. 56.
    Hahn JS, Pohl D, Rensel M, Rao S. Differential diagnosis and evaluation in pediatric multiple sclerosis. Neurology. 2007;68:S13–22.PubMedGoogle Scholar
  57. 57.
    Van der Knaap MS. Magnetic resonance of myelination and myelin disorders. 3rd ed. New York: Springer; 2005.Google Scholar
  58. 58.
    Gorman MP, Golomb MR, Walsh LE, et al. Steroid-responsive neurologic relapses in a child with a proteolipid protein-1 mutation. Neurology. 2007;68:1305–7.PubMedGoogle Scholar
  59. 59.
    Chitnis T. Pediatric multiple sclerosis. Neurologist. 2006;12:299–310.PubMedGoogle Scholar
  60. 60.
    Mikaeloff Y, Caridade G, Suissa S, Tardieu M. Clinically observed chickenpox and the risk of childhood-onset multiple sclerosis. Am J Epidemiol. 2009;169:1260–6.PubMedGoogle Scholar
  61. 61.
    Mikaeloff Y, Caridade G, Suissa S, Tardieu M. Hepatitis B vaccine and the risk of CNS inflammatory demyelination in childhood. Neurology. 2009;72:873–80.PubMedGoogle Scholar
  62. 62.
    Mikaeloff Y, Caridade G, Tardieu M, Suissa S. Parental smoking at home and the risk of childhood-onset multiple sclerosis in children. Brain. 2007;130:2589–95.PubMedGoogle Scholar
  63. 63.
    Correale J, Tenembaum SN. Myelin basic protein and myelin oligodendrocyte glycoprotein T-cell repertoire in childhood and juvenile multiple sclerosis. Mult Scler. 2006;12:412–20.PubMedGoogle Scholar
  64. 64.
    Banwell B, Bar-Or A, Cheung R, et al. Abnormal T-cell reactivities in childhood inflammatory demyelinating disease and type 1 diabetes. Ann Neurol. 2008;63:98–111.PubMedGoogle Scholar
  65. 65.
    Barnes D, Hughes RA, Morris RW, et al. Randomised trial of oral and intravenous methylprednisolone in acute relapses of multiple sclerosis. Lancet. 1997;349:902–6.PubMedGoogle Scholar
  66. 66.
    Martinelli V, Pulizzi A, Annovazzi P, Rocca M, Rodegher M, et al. A short-term MRI study comparing high-dose oral versus intravenous methylpredisolone in MS relapse. Neurology. 2008;70:A83–4.Google Scholar
  67. 67.
    Morrow SA, Stoian CA, Dmitrovic J, Chan SC, Metz LM. The bioavailability of IV methylprednisolone and oral prednisone in multiple sclerosis. Neurology. 2004;63:1079–80.PubMedGoogle Scholar
  68. 68.
    Weinshenker BG, O’Brien PC, Petterson TM, Noseworthy JH. A randomized trial of plasma exchange in acute central nervous system inflammatory demyelinating disease. Ann Neurol. 1999;46:878–86.PubMedGoogle Scholar
  69. 69.
    Duzova A, Bakkaloglu A. Central nervous system involvement in pediatric rheumatic diseases: current concepts in treatment. Curr Pharm Des. 2008;14:1295–301.PubMedGoogle Scholar
  70. 70.
    Hahn JS, Siegler DJ, Enzmann D. Intravenous gammaglobulin therapy in recurrent acute disseminated encephalomyelitis. Neurology. 1996;46:1173–4.PubMedGoogle Scholar
  71. 71.
    Nishikawa M, Ichiyama T, Hayashi T, Ouchi K, Furukawa S. Intravenous immunoglobulin therapy in acute disseminated encephalomyelitis. Pediatr Neurol. 1999;21:583–6.PubMedGoogle Scholar
  72. 72.
    Mikaeloff Y, Caridade G, Tardieu M, Suissa S. Effectiveness of early beta interferon on the first attack after confirmed multiple sclerosis: a comparative cohort study. Eur J Paediatr Neurol. 2008;12:205–9.PubMedGoogle Scholar
  73. 73.
    Ghezzi A, Amato MP, Capobianco M, et al. Treatment of early-onset multiple sclerosis with intramuscular interferonbeta-1a: long-term results. Neurol Sci. 2007;28:127–32.PubMedGoogle Scholar
  74. 74.
    Pakdaman H, Fallah A, Sahraian MA, Pakdaman R, Meysamie A. Treatment of early onset multiple sclerosis with suboptimal dose of interferon beta-1a. Neuropediatrics. 2006;37:257–60.PubMedGoogle Scholar
  75. 75.
    Waubant E, Hietpas J, Stewart T, et al. Interferon beta-1a in children with multiple sclerosis is well tolerated. Neuropediatrics. 2001;32:211–3.PubMedGoogle Scholar
  76. 76.
    Mikaeloff Y, Moreau T, Debouverie M, et al. Interferon-beta treatment in patients with childhood-onset multiple sclerosis. J Pediatr. 2001;139:443–6.PubMedGoogle Scholar
  77. 77.
    Tenembaum SN, Segura MJ. Interferon beta-1a treatment in childhood and juvenile-onset multiple sclerosis. Neurology. 2006;67:511–3.PubMedGoogle Scholar
  78. 78.
    Banwell B, Reder AT, Krupp L, et al. Safety and tolerability of interferon beta-1b in pediatric multiple sclerosis. Neurology. 2006;66:472–6.PubMedGoogle Scholar
  79. 79.
    Adams AB, Tyor WR, Holden KR. Interferon beta-1b and childhood multiple sclerosis. Pediatr Neurol. 1999;21:481–3.PubMedGoogle Scholar
  80. 80.
    Krupp L, Pardo L, Vitt D. Clinical features and disease-modifying therapy experience in paediatric multiple sclerosis. Mult Scler. 2004;10:S178.Google Scholar
  81. 81.
    Kornek B, Bernert G, Balassy C, Geldner J, Prayer D, Feucht M. Glatiramer acetate treatment in patients with childhood and juvenile onset multiple sclerosis. Neuropediatrics. 2003;34:120–6.PubMedGoogle Scholar
  82. 82.
    Borriello G, Prosperini L, Luchetti A, Pozzilli C. Natalizumab treatment in pediatric multiple sclerosis: a case report. Eur J Paediatr Neurol. 2009;13(1):67–71.PubMedGoogle Scholar
  83. 83.
    Huppke P, Stark W, Zurcher C, Huppke B, Bruck W, Gartner J. Natalizumab use in pediatric multiple sclerosis. Arch Neurol. 2008;65:1655–8.PubMedGoogle Scholar
  84. 84.
    Yeh EA, Waubant E, Krupp L, Ness J, Chitnis T, Kuntz N, Ramanathan M, Belman A, Chabas D, Gorman M, Rodriguez M, Rinker J, Weinstock-Guttman B. MS Therapies in Pediatric MS Patients With Refractory Disease. Archives of Neurology 2011;68(4):437–444.Google Scholar
  85. 85.
    Makhani N, Gorman MP, Branson HM, Stazzone L, Banwell BL, Chitnis T. Cyclophosphamide therapy in pediatric multiple sclerosis. Neurology. 2009;72:2076–82.PubMedGoogle Scholar
  86. 86.
    Krupp LB, Rizvi SA. Symptomatic therapy for underrecognized manifestations of multiple sclerosis. Neurology. 2002;58:S32–9.PubMedGoogle Scholar
  87. 87.
    Murray TJ. Amantadine therapy for fatigue in multiple sclerosis. Can J Neurol Sci. 1985;12:251–4.PubMedGoogle Scholar
  88. 88.
    Krupp LB, Coyle PK, Doscher C, et al. Fatigue therapy in multiple sclerosis: results of a double-blind, randomized, parallel trial of amantadine, pemoline, and placebo. Neurology. 1995;45:1956–61.PubMedGoogle Scholar
  89. 89.
    A randomized controlled trial of amantadine in fatigue associated with multiple sclerosis. The Canadian MS Research Group. Can J Neurol Sci. 1987;14:273–8.Google Scholar
  90. 90.
    Rammohan KW, Lynn DJ. Modafinil for fatigue in MS: a randomized placebo-controlled double-blind study. Neurology. 2005;65:1995–7. author reply 1995–7.PubMedGoogle Scholar
  91. 91.
    Zifko UA, Rupp M, Schwarz S, Zipko HT, Maida EM. Modafinil in treatment of fatigue in multiple sclerosis. Results of an open-label study. J Neurol. 2002;249:983–7.PubMedGoogle Scholar
  92. 92.
    Weinshenker BG, Penman M, Bass B, Ebers GC, Rice GP. A double-blind, randomized, crossover trial of pemoline in fatigue associated with multiple sclerosis. Neurology. 1992;42:1468–71.PubMedGoogle Scholar
  93. 93.
    Pucci E, Branas P, D’Amico R, Giuliani G, Solari A, Taus C. Amantadine for fatigue in multiple sclerosis. Cochrane Database Syst Rev. 2007;(1):CD002818.Google Scholar
  94. 94.
    Rammohan KW, Rosenberg JH, Lynn DJ, Blumenfeld AM, Pollak CP, Nagaraja HN. Efficacy and safety of modafinil (Provigil) for the treatment of fatigue in multiple sclerosis: a two centre phase 2 study. J Neurol Neurosurg Psychiatry. 2002;72:179–83.PubMedGoogle Scholar
  95. 95.
    Stankoff B, Waubant E, Confavreux C, et al. Modafinil for fatigue in MS: a randomized placebo-controlled double-blind study. Neurology. 2005;64:1139–43.PubMedGoogle Scholar
  96. 96.
    Krupp LB, Christodoulou C, Melville P, Scherl WF, MacAllister WS, Elkins LE. Donepezil improved memory in multiple sclerosis in a randomized clinical trial. Neurology. 2004;63:1579–85.PubMedGoogle Scholar
  97. 97.
    O’Brien AR, Chiaravalloti N, Goverover Y, Deluca J. Evidenced-based cognitive rehabilitation for persons with multiple sclerosis: a review of the literature. Arch Phys Med Rehabil. 2008;89:761–9.PubMedGoogle Scholar
  98. 98.
    Cheung AH, Emslie GJ, Mayes TL. The use of antidepressants to treat depression in children and adolescents. CMAJ. 2006;174:193–200.PubMedGoogle Scholar
  99. 99.
    de Seze M, Ruffion A, Denys P, Joseph PA, Perrouin-Verbe B. The neurogenic bladder in multiple sclerosis: review of the literature and proposal of management guidelines. Mult Scler. 2007;13:915–28.PubMedGoogle Scholar
  100. 100.
    Chia YW, Fowler CJ, Kamm MA, Henry MM, Lemieux MC, Swash M. Prevalence of bowel dysfunction in patients with multiple sclerosis and bladder dysfunction. J Neurol. 1995;242:105–8.PubMedGoogle Scholar
  101. 101.
    Nortvedt MW, Riise T, Frugard J, et al. Prevalence of bladder, bowel and sexual problems among multiple sclerosis patients two to five years after diagnosis. Mult Scler. 2007;13:106–12.PubMedGoogle Scholar
  102. 102.
    DasGupta R, Fowler CJ. Bladder, bowel and sexual dysfunction in multiple sclerosis: management strategies. Drugs. 2003;63:153–66.PubMedGoogle Scholar
  103. 103.
    Hansel DE, Hansel CR, Shindle MK, et al. Oral baclofen in cerebral palsy: possible seizure potentiation? Pediatr Neurol. 2003;29:203–6.PubMedGoogle Scholar
  104. 104.
    Sgouros S, Seri S. The effect of intrathecal baclofen on muscle co-contraction in children with spasticity of cerebral origin. Pediatr Neurosurg. 2002;37:225–30.PubMedGoogle Scholar
  105. 105.
    Gronseth G, Cruccu G, Alksne J, et al. Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology and the European Federation of Neurological Societies. Neurology. 2008;71(15):1183–90.PubMedGoogle Scholar
  106. 106.
    Goodman AD, Cohen JA, Cross A, et al. Fampridine-SR in multiple sclerosis: a randomized, double-blind, placebo-controlled, dose-ranging study. Mult Scler. 2007;13:357–68.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Lauren Krupp
    • 1
  • Yashma Patel
    • 1
  • Vikram Bhise
    • 1
  1. 1.Department of NeurologyStony Brook University Medical CenterStony BrookUSA

Personalised recommendations