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Updated: Jul 4, 2026
Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
The natural history of multiple sclerosis with childhood onset
Christel Renoux1, Sandra Vukusic, Christian Confavreux
1Service de Neurologie A and EDMUS Coordinating Center, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France.
Insights
Childhood-onset multiple sclerosis (MS) progresses slower but reaches milestones at a younger age, challenging favorable prognosis notions. The underlying disease biology appears similar across all age groups.
Area of Science:
- Neurology
- Pediatric Neurology
- Autoimmune Diseases
Background:
- Childhood-onset multiple sclerosis (MS) is rare, affecting less than 5% of cases.
- Exacerbating-remitting forms are the most common initial presentation.
Purpose of the Study:
- To analyze the characteristics and long-term evolution of childhood-onset MS.
- To compare disease progression and prognosis between childhood-onset and adult-onset MS.
Main Methods:
- Retrospective analysis of childhood-onset multiple sclerosis cases.
- Comparison of disease milestones and progression rates with adult-onset MS cohorts (e.g., KIDMUS study).
Main Results:
- Childhood-onset MS patients experience a longer time to reach secondary progressive phase and disability landmarks compared to adult-onset MS.
- Despite slower progression, childhood-onset MS patients reach these critical phases at a younger age.
- Clinical phenotype is influenced by age at onset, but underlying pathophysiology remains consistent.
Conclusions:
- Childhood-onset MS has a complex long-term evolution, with delayed milestones but earlier achievement of disease stages.
- The notion of a more favorable prognosis for childhood-onset MS is challenged.
- Age at onset primarily affects MS clinical presentation, not the core biological disease process.
Abstract:
Multiple sclerosis with childhood onset has been extensively studied recently, increasing the knowledge of the characteristics and long-term evolution of the disease in this age group. It is a rare condition accounting for less than 5% of all cases with multiple sclerosis. Exacerbating-remitting forms are, by far, the most common presentation at onset. The evolution to the secondary progressive phase as well as the assignment to irreversible disability landmarks take longer in patients with childhood onset compared with patients with adult onset, as shown in the KIDMUS study. However, patients with childhood onset reach these different critical phases of the disease at a younger age than patients with adult onset, therefore contradicting the notion of a more favorable prognosis in this age group. With respect to the pathophysiology of the disease, age at onset probably influences mainly the clinical phenotype of multiple sclerosis but not the underlying biological process, suggesting a similar pathophysiology of the disease whatever age at onset.
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