Yuyi Wong

In Chapter 3.9, 24 newly diagnosed children with MS underwent extensive urological screening including uroflowmetry, with concurrent (non-invasive) electromyography of the pelvic floor muscles. A large number of children already had micturition problems within the first 18 months after diagnosis (21%). Micturition questionnaires were sufficient to detect 80% of patients with a neurogenic bladder; one patient would have been missed if these children had not been systematically referred for urological screening. Physicians treating children with MS should be alert to the occurrence of neurogenic bladder disease early in the course of the disease.

The change in MRI lesions during follow-up of ADEM patients has been little studied. In Chapter 3.10, 42 children with ADEM were included for analysis. In ADEM children who had ≥2 MRI scans in the acute phase (first 3 months after onset of symptoms) and ≥1 scan after the acute phase, we observed that changes in MRI abnormalities lag behind clinical symptoms: in 3/42 patients, the MRI was normal at onset (performed at 3, 7, and 30 days) and abnormalities only became visible on follow-up scans made on days 26, 36, and 40 respectively. Additionally, worsening of MRI abnormalities (e.g., increase in size or new lesions) often occurs during the acute phase despite clinical improvement. An increase in abnormalities rarely occurs after the first three months. Therefore, we recommend performing a new MRI 3 months after the onset of symptoms as a new baseline for future attacks.

The main findings of our studies are summarized and discussed in Chapter 4, where recommendations for future research are also provided.