Abstract：
Pediatric-onset multiple sclerosis (POMS) is the most common demyelinating disease in children. Patients suffer from physical disability, cognitive impairment, and psychosocial challenges. Management requires a multidisciplinary care team. Here we present a case of an 11-year-old boy with POMS who relocated to Guam prior to initiation of a disease-modifying treatment and who experienced a flare without immediate access to an MRI or a child neurologist. Care required the combined efforts of ophthalmology, pediatrics, and emergency medicine in Guam, real-time remote guidance by child neurology, and asynchronous collaboration with cardiology and child neurology. As a result, the immediate flare was accurately diagnosed and treated with steroids, the patient was started on Fingolimod, and an emergency management plan for future flares was constructed. This case illustrates the nuances of both the acute and chronic management of multiple sclerosis in a resource-limited setting and how a combination of synchronous and asynchronous telemedicine was able to achieve a satisfactory treatment plan.
摘要：
小儿多发性硬化（POMS）是儿童中最常见的脱髓鞘疾病。患者身体残疾，认知障碍，和心理社会挑战。管理需要一个多学科的护理团队。在这里，我们介绍了一例患有POMS的11岁男孩，他在开始疾病修饰治疗之前就搬到了关岛，并且在没有立即获得MRI或儿童神经科医生的情况下经历了耀斑。护理需要眼科的共同努力，儿科,关岛的急诊医学，儿童神经病学的实时远程指导，以及与心脏病学和儿童神经病学的异步合作。因此,即时耀斑被准确诊断并用类固醇治疗，病人开始服用芬戈莫德，并制定了未来耀斑的应急管理计划。此案例说明了在资源有限的情况下，多发性硬化症的急性和慢性管理的细微差别，以及同步和异步远程医疗的组合如何能够实现令人满意的治疗计划。
