Understanding MS in children

There are several Pediatric MS centers of Excellence in the USA . The information showing below pertains to one of these.

Although multiple sclerosis (MS) most commonly affects people who are ages 20 to 40, as many as 5 percent of MS patients develop symptoms during childhood. Yet many features of the natural history of pediatric MS, as well as best practices for diagnosing and treating the disease, are not fully understood.

Mayo Clinic in Rochester, Minn., has been recognized by the National Multiple Sclerosis Society as a “pediatric MS center of excellence.” The multidisciplinary practice focuses on evaluating and treating children with MS and other central nervous system (CNS) disorders. In conjunction with five similarly designated centers, Mayo researchers also are enrolling patients in a database to support studies on the causes and management of these CNS disorders in children.

“Our goal is to learn more about pediatric MS so we can establish treatment guidelines and standards and be in a leading position to offer the best care for these patients,” says Jan-Mendelt Tillema, M.D., a pediatric neurologist at Mayo Clinic in Rochester, Minn.

Axial T2 FLAIR and post-gadolinium T1 images of children with MS

For physicians, the challenges of pediatric MS begin with diagnosis. Magnetic resonance imaging (MRI) plays a large role, as it does in adults. “But magnetic resonance imaging of children can be much more difficult to interpret,” Dr. Tillema says. For example, lesions may be less sharply demarcated. Distinguishing between MRI patterns in MS and acute disseminated encephalomyelitis (ADEM) — which occurs more frequently in children and adolescents than does MS — can be challenging, particularly after a single episode of signs and symptoms.

Following subsequent attacks, MRI often can show clearer evidence of disease, which is required to make the diagnosis of MS. Dr. Tillema notes that research studies with a small number of patients suggest MS attacks tend to occur more frequently in the initial phase of the disease in children than in adults — a feature he has witnessed in his own practice. “It’s not uncommon for kids to have a few attacks within a year or two, whereas in adults it is more often — but not always — the case that episodes are spread out over several years,” he says.

Treatment for pediatric MS relies on the same medications used in adults, although randomized controlled trials needed for Food and Drug Administration approval of such medications have not included pediatric patients. One of the major goals of the pediatric centers of excellence is to facilitate large-scale research initiatives.

“There is increasing experience in using MS medications in kids. Based on studies of these cases, we know more about the similarities and differences in both efficacy and side effect profiles in children,” Dr. Tillema says. “The future target is to find the safest and best drugs to treat MS in children, rather than extrapolating that information from adult studies.”

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