Schilder type multiple sclerosis

Last revised by Rohit Sharma on 23 Apr 2019

Schilder disease, also known as diffuse myelinoclastic sclerosis or diffuse cerebral sclerosis, is considered a variant of multiple sclerosis, and represents an extremely rare progressive demyelinating process that begins in childhood 1,4.

The disease is extremely rare with less than 10 cases reported in the literature that fulfill the original Poser diagnostic criteria 1.

Symptoms include aphasia, balance instability, dementia, headache, incontinence, personality changes, seizures, tremors, visual disturbances and weakness 1.

Proposed by Poser in 1985, all six criteria must be met 2:

  • 1-2 large plaques: should be in each brain hemisphere predominantly in centrum semiovale, lesions are greater than 2 cm in 2/3 dimensions 3
  • no additional lesions identified
  • no peripheral nervous system abnormality
  • normal adrenal function
  • normal serum long chain fatty acids 
  • pathological/histological changes consistent with subacute/chronic myelinoclastic diffuse sclerosis 

Schilder type multiple sclerosis is characterized by 1-2 large demyelinating plaques, which are hyperintense on T2-weighted images, in each cerebral hemisphere, predominantly in the centrum semiovale. Lesions typically are greater than 2 cm in diameter 3.

Typically, the cerebral cortex, cerebellum, brainstem, and spinal cord are relatively spared 5.

Patients have a poor prognosis. Current recommendations are high dose corticosteroids and supportive care 3.

Shilder disease is named after Paul Ferdinand Schilder (1886-1940), the Austrian psychiatrist and researcher who first described the disease in 1912.

Appearances, clinical presentation and histological findings are similar to tumefactive demyelinating lesions, and it has been proposed that Schilder type multiple sclerosis may actually merely represent the pediatric version of tumefactive demyelinating lesions 4.

Appearances are also similar to Marburg variant of multiple sclerosis, although the brainstem is usually spared, and response to steroids is more common 4.

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