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Pediatric Multiple Sclerosis: an Update
Scott Otallah1, Brenda Banwell2,3
1Pediatric Multiple Sclerosis and Demyelinating Disorders Clinic, Division of Pediatric Neurology, Department of Neurology, Wake Forest University/Brenner Children's Hospital, Medical Center Boulevard, JT9, Winston Salem, NC, 27157, USA. sotallah@wakehealth.edu.
Insights
Recent advancements in pediatric-onset multiple sclerosis (POMS) include updated diagnostic criteria and insights into disease impact. Research now better defines POMS, guiding improved care for affected children.
Area of Science:
- Pediatric Neurology
- Demyelinating Diseases
- Neuroimmunology
Background:
- Pediatric-onset multiple sclerosis (POMS) and related demyelinating disorders require updated diagnostic and management strategies.
- Advances in neuroimaging, biological assays, and clinical trials are transforming the understanding and treatment of these conditions in children.
Purpose of the Study:
- To provide healthcare providers with current updates on POMS and related demyelinating disorders.
- To summarize recent findings in diagnosis, neuroimaging, biomarkers, treatment, and outcomes for pediatric MS.
Main Methods:
- Review of updated diagnostic criteria (2017 McDonald Criteria) for applicability to POMS.
- Analysis of neuroimaging studies revealing brain volume changes and tissue integrity.
- Examination of biological assays for antibodies (e.g., MOG antibodies) and their diagnostic/prognostic significance.
- Evaluation of data from clinical trials on treatment efficacy and safety (e.g., fingolimod vs. interferon beta 1a).
- Assessment of longitudinal studies on neurological, cognitive, and quality of life outcomes.
Main Results:
- The 2017 McDonald Criteria are applicable to POMS, simplifying diagnosis.
- Neuroimaging shows reduced brain volume at onset and progressive decline, similar to adult MS.
- Myelin oligodendrocyte glycoprotein (MOG) antibodies are present in over 50% of acute disseminated encephalomyelitis cases in children and can indicate relapsing disease.
- Fingolimod demonstrated superiority over subcutaneous interferon beta 1a with a favorable safety profile in clinical trials.
- Despite low Expanded Disability Status Scale scores early on, POMS is linked to fatigue, reduced exercise, and cognitive impairment risks.
Conclusions:
- Significant progress has been made in recognizing and researching POMS over the last 15 years.
- More specific diagnostic criteria and antibody biomarkers are defining distinct disorders.
- Clinical trials are yielding evidence for effective and safe treatments.
- A deeper understanding of POMS' impact on children's neurological function, cognition, and quality of life is emerging.
Purpose Of Review:
Diagnostic criteria for pediatric-onset multiple sclerosis (POMS) and related demyelinating disorders have been updated, neuroimaging studies have revealed new insights, biological assays identify patients with specific antibodies that influence both diagnosis and treatment, clinical trials are informing on treatment efficacy and safety, and longitudinal studies of neurological, cognitive and quality of life outcomes are informing on the impact of these diseases. We provide updates to assist providers caring for these children.
Recent Findings:
The recent 2017 McDonald Criteria for MS provide a simplified means to confirm diagnosis at onset and over time, and have been shown to be equally applicable for POMS. MRI analyses demonstrate that brain volume is reduced at onset, and that both volumetric and tissue integrity measures decline over time, indicating that POMS shares the degenerative aspects that also characterize adult-onset disease. The presence of myelin oligodendrocyte glycoprotein (MOG) antibodies at onset is detected in more than 50% of children with acute disseminated encephalomyelitis. When persistent over time, they are associated with relapsing disease. The first randomized clinical trials of disease supports superiority of fingolimod over subcutaneous interferon beta 1a, and demonstrated a favorable safety profile. Finally, while Expanded Disability Status Scale (EDSS) scores remain low in the first 10 years post-onset, POMS is associated with high rates of patient-reported fatigue and reduced engagement in exercise and carries a risk for cognitive impairment. The past 15 years have borne witness to a marked expansion in recognition and research in POMS. There are now more specific diagnostic criteria, antibodies to CNS proteins appear to define diagnostically distinct disorders, clinical trials have successfully launched and one has completed, and we are gaining increasing appreciation of the impact of MS and related disorders on the lived experience of children and adolescents.
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