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Published on: June 30, 2014
Pediatric multiple sclerosis
Dorothee Chabas1, Jonathan Strober, Emmanuelle Waubant
1University of California, San Francisco, Regional Pediatric Multiple Sclerosis Center, 350 Parnassus Avenue, Suite 908, San Francisco, CA 94117, USA. dorothee.chabas@ucsf.edu
Insights
Diagnosing pediatric multiple sclerosis (MS) is difficult due to overlapping symptoms with other conditions. Children with MS face unique challenges, including different MRI findings and slower disability progression, yet often receive unproven adult treatments.
Area of Science:
- Neurology
- Pediatrics
- Immunology
Background:
- Diagnosing pediatric multiple sclerosis (MS) presents unique challenges compared to adults, stemming from limited diagnostic criteria and symptom overlap with acute disseminated encephalomyelitis.
- Pediatric MS often manifests with distinct clinical and radiological features, including a higher prevalence of male patients, seizures, brainstem/cerebellar involvement, and specific MRI findings like posterior fossa lesions.
Purpose of the Study:
- To highlight the diagnostic difficulties and clinical characteristics of pediatric-onset multiple sclerosis.
- To underscore the implications of delayed diagnosis and the current treatment landscape for children with MS.
Main Methods:
- Review of clinical presentation, diagnostic criteria, and MRI findings in pediatric-onset multiple sclerosis.
- Comparison of pediatric MS characteristics with adult-onset MS.
- Analysis of disease progression, treatment approaches, and clinical trial limitations in pediatric MS.
Main Results:
- Pediatric MS patients exhibit differences from adults, such as male predominance, seizures, and brainstem/cerebellar symptoms, with less frequent spinal cord involvement.
- Initial brain MRIs in prepubertal children may show posterior fossa involvement and less defined, more confluent lesions that resolve over time.
- Despite slower disability progression, pediatric MS leads to significant disability at a younger age, with potential disparities in non-white populations.
Conclusions:
- Pediatric-onset multiple sclerosis requires specialized diagnostic considerations due to its unique presentation and imaging features.
- The rarity of pediatric MS limits clinical trial participation, leading to off-label use of adult therapies with unknown efficacy and tolerability in children.
- Further research and dedicated clinical trials are crucial to improve diagnosis, treatment, and outcomes for children with multiple sclerosis.
Abstract:
Diagnosing multiple sclerosis (MS) in a child is challenging because of the limited diagnostic criteria and their overlap with acute disseminated encephalomyelitis. Pediatric-onset MS patients are more likely to be male, have seizures, and have brainstem and cerebellar symptoms than adults, and are less likely to have spinal cord symptoms than adults. They mostly experience a relapsing-remitting course. Their initial brain MRI shows more frequent involvement of the posterior fossa, less well-defined ovoid lesions, and more confluent lesions that decrease over time in patients with prepubertal onset, making early diagnosis even more difficult. Although disability progression is slower than in adults, pediatric onset MS leads to significant disability at a younger age and may be worse in non-white patients (up to 50% in North America). The rareness of pediatric-onset MS has precluded enrollment in clinical trials. Thus, children are receiving off-label adult therapies without clear evidence of their effectiveness and limited knowledge of their tolerability.
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