Pediatric Multiple Sclerosis

Multiple sclerosis (MS) is primarily a disease of adults. However, MS onset in children accounts for up to 5% of all MS cases. 

Over the last 10 years, much has been learned about the epidemiology, pathophysiology, diagnosis, and treatment of MS in children. Several exciting discoveries have stressed the importance of genetic and environmental factors. Notable examples include human leukocyte antigen (HLA) subtypes and viral exposures, among others. There are phenotypic differences, including clinical, MRI, and laboratory findings, between adults and children, especially before puberty.

For example, in young children, the first presentation of MS may be indistinguishable from acute disseminated encephalomyelitis(ADEM). In addition, the initial brain MRI scan in younger patients shows more frequent involvement of the posterior fossa and higher numbers of ill-defined T2-bright foci that often partially resolve on the follow-up scan, thereby challenging early diagnosis. Finally, the spinal fluid in younger patients may fail to reveal oligoclonal bands (OCBs) or elevated immunoglobulin G (IgG) index at disease onset.

The treatment of pediatric patients with MS is based on randomized controlled data in adults. PARADIGMS, the only randomized controlled trial for safety and efficacy of fingolimod versus interferon beta-1a in pediatric patients with MS, has shown comparable efficacy and safety profile to adults. Retrospective data have shown other disease-modifying therapies to be effective. This is one of the several areas that require more study.