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Pediatric multiple sclerosis: developments in timely diagnosis and prognostication
Monica Margoni1,2, Paolo Preziosa1,3, Maria A Rocca1,3,4
1Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Insights
Pediatric-onset multiple sclerosis (MS) is a severe condition impacting young patients. Early diagnosis and treatment are crucial for managing long-term disability and understanding disease progression.
Area of Science:
- Neuroimmunology
- Pediatric Neurology
Background:
- Pediatric-onset multiple sclerosis (MS) comprises 2-10% of all MS cases.
- Recent advancements have improved understanding of POMS pathophysiology, diagnosis, and prognosis.
Purpose of the Study:
- To review current knowledge on POMS pathophysiology, diagnostic criteria, and prognostic markers.
- To highlight the impact of POMS on brain maturation and long-term disability.
Main Methods:
- Literature review of recent updates on POMS.
- Analysis of clinical, neuroradiological, and laboratoristic markers for disease progression.
Main Results:
- PO MS presents with significant early clinical and radiological activity.
- Patients experience disability accumulation at a younger age compared to adults.
- Brain plasticity's role in counterbalancing damage is under investigation.
Conclusions:
- PO MS requires early and accurate diagnosis and treatment.
- Understanding POMS aids in comprehending MS pathogenesis and brain development impacts.
- Identifying prognosticators is key to managing long-term outcomes in pediatric MS patients.
Introduction:
Pediatric-onset (PO) multiple sclerosis (MS) accounts for about 2-10% of the total MS cases. Recently, a greater attention has been given to POMS, with substantial improvements in the understanding of its pathophysiology, in the diagnostic work-up and in the identification of reliable prognosticators associated with long-term disability in these patients.
Areas Covered:
This review summarizes the most recent updates regarding the pathophysiology of POMS, the current diagnostic criteria and the clinical, neuroradiological and laboratoristic markers that have been associated with disease progression (i.e. occurrence of a second clinical attack at disease onset and accumulation of disability in definite MS).
Expert Opinion:
The study of POMS, where the clinical onset is closer to the biological onset of MS, may contribute to better understand how the different pathological processes impact brain maturation and contribute to disease progression, but also how brain plasticity may counterbalance structural damage accumulation. Although rare, POMS is a severe disease, characterized by a prominent clinical and radiological activity at disease onset and by the accumulation of physical and cognitive disability at a younger age compared to the adult counterpart, with significant detrimental consequences at long-term. Early and accurate diagnosis, together with early treatment, is highly warranted.
