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Pediatric multiple sclerosis
1Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. Sandra.Bigi@sickkids.ca
Insights
Pediatric multiple sclerosis (MS) affects 3-5% of MS patients, presenting as relapsing-remitting disease. Childhood MS leads to significant disability and cognitive impairment earlier than adult-onset MS.
Area of Science:
- Neurology
- Pediatrics
- Immunology
Background:
- Pediatric multiple sclerosis (MS) is increasingly recognized, accounting for 3-5% of all MS cases.
- Childhood-onset MS typically follows a relapsing-remitting course.
- The initial presentation, or acquired demyelinating syndrome, can include optic neuritis, transverse myelitis, and acute disseminated encephalomyelitis.
Purpose of the Study:
- To review the characteristics, diagnosis, and morbidity of pediatric multiple sclerosis.
- To highlight the differences in disease course and progression between childhood-onset and adult-onset MS.
Main Methods:
- Diagnosis requires clinical and MRI evidence of dissemination in space and time.
- Exclusion of other neurological disorders is critical for accurate diagnosis.
- Assessment of clinical outcomes including cognitive impairment, depression, and fatigue.
Main Results:
- Significant morbidity is observed within two years of onset: 30% cognitive impairment, 50% depression, 75% fatigue.
- Relapse rates in pediatric MS are higher compared to adult-onset MS.
- Despite initial good recovery, childhood-onset MS patients reach secondary progressive disease or permanent disability approximately 10 years earlier than adults.
Conclusions:
- Pediatric multiple sclerosis has a distinct and often more aggressive disease course than adult-onset MS.
- Early recognition and management are crucial to mitigate long-term disability and cognitive sequelae.
- Further research is needed to optimize treatment strategies for children with MS.
Abstract:
Pediatric multiple sclerosis has been increasingly recognized in the past 10 to 15 years; 3% to 5% of all multiple sclerosis patients experience their first attack in childhood. Childhood multiple sclerosis has a relapsing-remitting disease course. The first attack, or "acquired demyelinating syndrome," consists of optic neuritis, transverse myelitis, acute disseminated encephalomyelitis, and monofocal or polyfocal neurological deficits. The diagnosis of multiple sclerosis necessitates the clinical or magnetic resonance imaging confirmation of dissemination in space and time and exclusion of other disorders. The morbidity of childhood multiple sclerosis is significant; within the first 2 years from onset, 30% of children have significant cognitive impairment, 50% show signs of depression, and 75% are fatigued. The relapse rate in children with multiple sclerosis is higher than in adult-onset disease. Following acute treatment, recovery after the first attacks is usually excellent, but patients with childhood-onset multiple sclerosis reach permanent disability or enter the secondary progressive disease course 10 years younger than patients with adult-onset multiple sclerosis.
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