Thank you for sending us your comment on our case with dystonia and secondary progressive multiple sclerosis. As you mentioned, in childhood, multiple sclerosis is very rare, and clinical presentations of seizure or dystonia are also very rare. Unfortunately we have not examined serum lactate or pyruvate. MELAS is a possible diagnosis in this case, but clinical course was not typical of it. His acute symptoms had been resolved with steroid treatment, and after two acute presentations he has no attacks for almost 5 years. He had no mental retardation. At 13 years of age, the number of activated lymphocytes (IL-SR; positive and T4) in CSF was slightly high, suggesting mild inflammation in CSF. We clinically diagnosed his illness as secondary progressive multiple sclerosis. We admit that mitochondrial disorders and other autoimmune disorders are in the list of differential diagnosis. We will evaluate his lactate, pyruvate, and autoantibodies in future.
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© 2005 Elsevier B.V. Published by Elsevier Inc. All rights reserved.