Pediatric Multiple Sclerosis Manifesting with Primary Psychiatric Symptoms

Neurocognitive effects of multiple sclerosis are increasingly recognized in both adult and pediatric MS populations. In addition, secondary mood disorders related to being diagnosed with a neurodegenerative condition, to especially include depression, are not uncommon and can negatively affect long-term quality of life outcomes. Primary psychiatric manifestations of multiple sclerosis are unusual, and the underlying demyelinating disease may not be discovered until more typical attack symptoms occur. This chapter presents pediatric multiple sclerosis with an initial psychiatric presentation. A 14-year-old boy initially presented with symptoms of depression, paranoia, and new-onset migraine. He required inpatient psychiatric hospitalization for worsening of these symptoms as well as new visual and auditory hallucinations. During the hospitalization he developed facial numbness, visual complaints, and leg weakness. He was ultimately diagnosed with multiple sclerosis (MS) which responded to treatment with glatiramer acetate and psycho-pharmacotherapy. Aspects of primary psychiatric disease in multiple sclerosis and its treatment will be reviewed.