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The Multiple Sclerosis Performance Test (MSPT): An iPad-Based Disability Assessment Tool
Published on: June 30, 2014
Pediatric multiple sclerosis
Dorothée Chabas1, Ari J Green, Emmanuelle Waubant
1University of California at San Francisco, Multiple Sclerosis Center, 94117, USA. dorothee.chabas@ucsf.edu
Insights
Childhood multiple sclerosis (MS) diagnosis is complex, differing from adults in symptoms and MRI findings. Pediatric MS treatment lacks trials, leading to off-label adult therapy use with limited understanding of effects.
Area of Science:
- Neurology
- Pediatrics
- Immunology
Background:
- Multiple sclerosis (MS) affects children, representing up to 10% of all cases.
- Diagnosing pediatric MS is challenging due to limited criteria and overlap with other conditions like acute disseminated encephalomyelitis.
- Pediatric MS presents unique clinical and magnetic resonance imaging (MRI) features compared to adult MS.
Purpose of the Study:
- To review the distinct characteristics of pediatric multiple sclerosis (MS).
- To highlight diagnostic challenges and differences in clinical presentation and MRI findings in children with MS compared to adults.
- To discuss the current state of disease-modifying therapies (DMTs) for pediatric MS and the need for further research.
Main Methods:
- Review of existing literature on pediatric multiple sclerosis.
- Comparison of clinical and MRI findings in pediatric MS versus adult MS.
- Analysis of current treatment approaches and tolerability data for approved adult MS therapies in children.
Main Results:
- Pediatric MS shows different sex ratios, symptom prevalence (seizures, brainstem/cerebellar), and MRI findings (fewer T2 lesions) compared to adults.
- Children with MS may experience significant disability at a younger age, impacting life stages.
- Lack of pediatric-specific clinical trials for DMTs results in off-label use and limited understanding of efficacy and tolerability.
Conclusions:
- Pediatric MS is a distinct entity requiring tailored diagnostic and therapeutic strategies.
- Further research and controlled trials are crucial to establish effective and safe DMTs for children with MS.
- Understanding the long-term impact and management of MS in pediatric populations is essential.
Abstract:
Multiple sclerosis (MS) occurs at all ages of the pediatric population. Childhood MS may represent up to 10% of all MS cases. Establishing the diagnosis of MS in a child is complicated by the limited diagnostic criteria and the possibility of significant clinical and magnetic resonance imaging (MRI) overlap with acute disseminated encephalomyelitis and other pediatric diseases. Although the clinical profile of MS appears similar to that seen in adults, several features may differ and specific issues arise in children. Sex ratios are different between young children with MS and adolescents--implicating a role for sex hormones in disease pathogenesis and/or modification of disease expression. Younger patients with MS are more likely to have seizures, brainstem, and cerebellar symptoms than adults. Children with MS may have fewer T2 hyperintense areas on MRI scans, therefore not meeting MRI criteria established for adults. It is possible that the pediatric MS course is more indolent than in adult patients but the disease may lead to significant disability at a younger age, e.g., while patients are students, young professionals, or want to start a family. There has been no controlled clinical trial in children with disease modifying therapies approved for adult MS due to the limited number of patients under the age of 18 years compared with the adult contingent. As a result, children are receiving adult therapies in an arbitrary manner and our understanding of pediatric treatment effect and tolerability is limited. Available data on tolerability of approved drugs for adults is reviewed.
