Pediatric multiple sclerosis

Multiple sclerosis (MS) is most commonly diagnosed between ages 20 and 40, but it can occur at any age. When onset happens before age 18, it is known as pediatric MS, or pediatric-onset MS (POMS).

MS is a neurodegenerative disease in which the immune system erroneously attacks healthy parts of the central nervous system (CNS), or the brain and spinal cord.

Pediatric MS is a rare form of the disease, accounting for about 3%-10% of all MS cases. Fewer than 5,000 children and teens are estimated to live with MS in the U.S., and fewer than 10,000 are thought to be affected worldwide.

While many aspects of pediatric MS diagnosis, symptoms, and treatment are similar to adult-onset disease, there are unique considerations for managing the condition in children and adolescents.

Symptoms of pediatric MS

The symptoms of pediatric MS are generally similar to those seen in adults. Common signs of MS in children may include:

vision issues, due to inflammation in the optic nerves, which send signals between the eyes and the brain
numbness, tingling, or other abnormal sensations
muscle weakness or stiffness
tremors (involuntary shaking) or spasms
difficulties with balance and coordination
severe fatigue that has an impact on a child’s usual activities
problems with concentration or memory, like taking longer to complete schoolwork or answer questions
mood changes
problems with bowel or bladder control

While many of the symptoms are similar between children and adults, there are typically some key distinguishing features in disease presentation:

Nearly all cases of pediatric MS are diagnosed as relapsing-remitting MS (RRMS), a form of the disease characterized by periods of symptom worsening (relapses) interspersed with periods where symptoms ease (remission).
Primary-progressive MS (PPMS), where disability steadily accumulates from disease onset, is extremely rare in children.
Relapses tend to occur more frequently in children than adults, but pediatric patients generally recover from them more completely and more quickly.

Diagnosis of pediatric MS

As there is no single symptom or test result that can definitely identify MS, establishing a diagnosis can be complex. Still, the general framework used to diagnose MS is now similar for children and adults.

Under the updated McDonald criteria, doctors can use similar tests in children to look for patterns consistent with the disease. These may include:

a neurological exam, to detect clinical impairments related to the disease
MRI scans, to look for lesions or damage in the CNS typical of MS
a lumbar puncture, or spinal tap, to look for signs of inflammation in the fluid surrounding the brain and spinal cord consistent with MS
evoked potential tests, to assess how well nerve cells are sending electrical signals
vision tests, to look for damage to the optic nerves and related symptoms
blood and urine tests, to rule out infections or other conditions that can mimic MS symptoms

Challenges in diagnosing pediatric MS

While the diagnostic process is generally the same, identifying MS in children can be more challenging than in adults. That’s because early-onset MS is quite rare, and there are other childhood disorders with similar symptoms that must be excluded before a diagnosis can be made.

The main differential diagnoses for pediatric MS include:

acute disseminated encephalomyelitis, an inflammatory immune disorder
neuromyelitis optica spectrum disorder, typically marked by inflammation of the optic nerve
systemic autoimmune diseases, such as lupus, neurosarcoidosis, and Sjögren’s disease
hereditary metabolic conditions that affect the nervous system
brain tumors or infections

Treatment of pediatric MS

A child’s care team is often led by a neurologist at a pediatric MS center, where diverse specialists work together to determine the best treatment approach based on each child’s needs.

As with adults, the treatment of MS in children generally takes a three-pronged approach:

treating acute MS relapses when they happen
slowing long-term disease progression with disease-modifying therapies (DMTs)
managing symptoms to improve overall well-being and quality of life

Most MS relapses in children are managed with a short course of corticosteroids. These are powerful anti-inflammatory medications that help ease brain inflammation to promote faster recovery, though they do not change the long-term progression of MS.

Gilenya (fingolimod) is currently the only DMT approved in the U.S. for pediatric use. The once-daily oral medication can specifically be used in children, ages 10 and older, with relapsing forms of MS.

Other DMTs approved for adults may sometimes be prescribed off-label for children if doctors determine that the potential benefits outweigh the risks.

Symptom management often includes a combination of medications and rehabilitation approaches, as well as lifestyle changes that help children thrive while living with MS.

Outlook and long-term management of pediatric MS

Children and teens will require lifelong monitoring and care after being diagnosed with MS, as there is still no cure for the disease. With proper long-term management, however, most children have a good overall prognosis.

Some children diagnosed with RRMS will eventually develop secondary progressive MS, where symptoms steadily worsen and disability accumulates even in the absence of relapses.

The more relapses children experiences, the faster their disease is likely to progress. However, disability in children tends to accumulate much more slowly than it does in adults. Individuals with pediatric-onset MS take, on average, about 10 years longer after disease onset to transition to SPMS compared with adult-onset MS patients. Still, because they are diagnosed earlier, children with MS tend to reach key disability milestones at a younger age.

With prompt and proper care, most children with MS will have a normal life expectancy and lead full lives, doing things like playing sports, going to college, and having children.

Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.