Childhood-juvenile multiple sclerosis: clinical characteristics and treatment

The characteristics of multiple sclerosis with onset during childhood or adolescence are presented in this review. The clinical findings are similar to those of the adult form, but some aspects are peculiar: the high female to male ratio, occurrence of hyperacute forms, occurrence of encephalopatic symptoms and high relapse rate. The evolution is relapsing-progressive in most cases. Mild and severe disability are reached after a longer interval than in the adult form but, in spite of this, at a given age disability is higher. A high relapse rate, short interval between first and second attack and high disability after the first year are negative prognostic factors. Magnetic resonance imaging and cerebrospinal fluid data are discussed, with particular reference to differential diagnosis from acute disseminated encephalomyelitis. Currently, there are no controlled trials concerning subjects aged under 16 years. Some observations demonstrate that immunomodulatory drugs are well tolerated and have a beneficial effect, reducing the relapse rate and progression of the disease.