Successful management of Pediatric-onset Multiple sclerosis with Ocrelizumab

Introduction: Pediatric-onset multiple sclerosis is rare with an overall incidence of 2 -5 % among pediatric population and one of the leading causes of neurodisability in children. Although numerous disease-modifying drugs (DMD’S) have been used in the management of POMS, to our knowledge Ocrelizumab has not been reported in the management of Multiple Sclerosis in children. Methods and Results: A previously healthy 11-years-old boy presented with new onset diplopia with headache. He underwent MRI brain scan which revealed multiple hyperintense foci in subcortical and periventricular white matter on T2-weighted imaging without restricted diffusion. MRI spine was normal. Extensive workup including routine labs, autoimmune profile (ANA, Ds-DNA, ANCA, Anti-cardiolipin and Aquaporin-4 antibodies, NMDA and anti-MOG antibodies) were negative. CSF analysis showed positive oligoclonal bands. The child was initially treated with pulsed intravenous steroids followed by tapering course of oral steroids with reasonable improvement. A follow up MRI brain revealed increase in the white matter signal abnormalities suggesting dissemination in space and time confirming diagnosis of Relapsing-Remitting Multiple Sclerosis. Various DMD’s were discussed with family but due to risk of non-compliance to daily oral and injectable drugs Ocrelizumab was commenced as 6-monthly infusions. Patient showed a significant clinical response with no clinical relapses and stable MRI scans with no new lesions at 18-month follow up Conclusion: Our case report suggests Ocrelizumab use as an alternative DMD in pediatric-onset Multiple sclerosis who are at risk of non-compliance to standard MS medications. To our knowledge ours is a first case of use of Ocrelizumab.