A case of pediatric multiple sclerosis treated with fingolimod hydrochloride (FTY720)

<p>  Disease modifying drugs (DMDs) were reportedly efficacious against multiple sclerosis (MS) in adults. However, there have been few reports on the efficacy of DMDs in the treatment of pediatric MS. The patient was a previously healthy girl, with a history of frequent falls since she was 12 years and 8 months old, blurred vision of the right eye when she was 13 years old, and right-sided upper extremity numbness when she was 13 years and 8 months old. She developed diplopia and numbness of the right upper and lower extremities at 14 years old. The initial neurologic examination findings suggested a pyramidal tract disorder, right upper extremity muscle weakness, and a positive Romberg sign. T2-weighted imaging of brain MRI sequences showed high signal intensities in the deep white matter of the bilateral centrum semiovale, white matter around the bilateral ventricles, and the right cerebellar peduncle. The cerebrospinal fluid examination revealed oligoclonal bands and elevated myelin basic protein levels. She was diagnosed with relapsing-remitting MS, based on the temporal and spatial multiplicity of two or more clinical symptoms and two or more demyelinating lesions presenting more than 1 month apart. She was hospitalized and treated with intravenous methylprednisolone, which resulted in remission. She then received oral prednisolone (PSL), but her disease relapsed 2 weeks upon tapering PSL. The short-term relapse was managed via daily oral administration of Fingolimod hydrochloride (FTY720) when the patient was 14 years and 6 months old. Remission was attained after 2 months, but FTY720 was discontinued due to lymphopenia. After the lymphocyte counts had improved, FTY720 was readministered every other day when the patient was 14 years and 9 months old. After 7 months, FTY720 therapy was given 5 days weekly, and the patient remained in remission for more than one year without needing a greater PSL dose. This case showed that FTY720 therapy was a viable treatment option in pediatric patients with highly active MS.</p>