Brain Atrophy, Early Antibody Spread in Pediatric MS

For most people, the first symptoms of multiple sclerosis (MS) begin in adulthood, possibly after the disease has been simmering silently for years. But for some, MS begins in childhood. Two recent studies of pediatric relapsing-remitting MS have found more evidence that the two main disease processes—inflammation and neurodegeneration—may both begin at the earliest stages and interfere with overall brain growth and health.

Researchers think the onset of MS in children may be a window into the disease origins for everyone. Pediatric MS is rare, accounting for only 2% to 10% of all MS cases. Children share some MS risk factors with adults, such as immune-related genes, low vitamin D levels, and certain viral exposures, as well as similar antibody and T cell profiles (Waldman et al., 2014).

The new findings come from the Canadian Pediatric Demyelinating Disease Network, a prospective study that has grown to include 24 centers in Canada, and also the Children’s Hospital of Philadelphia, Pennsylvania, USA, where the lead investigator, Brenda Banwell, M.D., is now based. The study enrolls people under age 18 who suffer an acute demyelinating event. The one-time demyelinating attacks affect roughly 1 in 100,000 children. The events can be severe or fatal, but most children recover. Some will have recurrent or chronic attacks and be diagnosed with MS (Banwell et al., 2011).

Although the two studies drew from the same population of children, they were conducted by different research teams and used different techniques to answer different questions. One group profiled blood samples with antigen microarray technology and found a pattern of growing antibody reactivity, also called epitope spreading, that distinguished MS from a one-time demyelinating illness within months of the first attack (Quintana et al., 2014).

If confirmed, the findings could pave the way for a predictive clinical test for childhood-acquired demyelinating syndromes, according to an accompanying editorial by Bernhard Hemmer, M.D., of Technical University, Munich, Germany, and Peter Calabresi, M.D., of Johns Hopkins University in Baltimore, Maryland, USA (Hemmer and Calabresi, 2014).

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