Multiple sclerosis (MS) is commonly known to affect adults, with most people diagnosed between the ages of 20 and 40 years. However, children can also develop MS. In people younger than 18 years, the condition is generally referred to as pediatric MS or pediatric-onset MS (POMS).

In general, pediatric MS is similar to the adult variant. Both involve the immune system attacking areas of the central nervous system (CNS), destroying the myelin sheath that covers nerve cells. The diagnosis, symptoms, and treatments for pediatric MS are similar to those of the adult version. However, POMS has some distinctive characteristics.

Prevalence and Demographics

Pediatric MS is a relatively rare disease, affecting an estimated 5,000 children in the United States and fewer than 10,000 children globally. Only 3 percent to 5 percent of adults living with MS will be diagnosed with the disease before the age of 18.

Most children living with pediatric MS are diagnosed between the ages of 10 and 12. Boys and girls have an equal chance of developing the disease. However, more girls tend to develop the disease after the age of 12, a trend that may be related to hormones and puberty.

Symptoms of Pediatric MS

The symptoms experienced during MS are a result of the demyelination that occurs in the CNS, which includes the brain and spinal cord. The symptoms of pediatric MS include:

• Numbness and tingling
• Pain
• Difficulty with movement, walking, or maintaining balance
• Fatigue
• Tremors
• Dizziness
• Difficulty with concentration and memory
• Blurry or double vision

Studies have also shown that children with pediatric MS can have more cognitive symptoms compared to adults with the disease.

In adults, there are several types of MS, including relapsing-remitting MS (RRMS), secondary progressive MS (SPMS), and primary progressive MS. Children almost exclusively present with RRMS. This means most children will experience a time period with disease activity (during relapse) and then periods without disease activity and symptoms (during remission). Studies suggest that children with pediatric MS experience more relapses compared to adults, but they also tend to have a better recovery.

Risk Factors for Pediatric MS

Experts do not fully understand what causes pediatric MS. As with adult MS, known environmental risk factors for pediatric MS include:

• Obesity
• Low levels of vitamin D
• Exposure to cigarette smoke
• Infection with Epstein-Barr virus

There are also genetic risk factors, such as the expression of a variation of a human leukocyte antigen gene (HLA) — known as HLA-DRB1*15:01 — which may play a role in the autoimmune dysfunction that occurs during MS.

Diagnosing Pediatric MS

Pediatric MS can be difficult for a neurologist to diagnose because its symptoms are similar to some other conditions and demyelinating disorders, including acute disseminated encephalomyelitis, clinically isolated syndrome, and neuromyelitis optica. A child must have at least two separate demyelinating events at different times and in different areas of the central nervous system to be diagnosed with MS.

Similar to adult MS, the demyelination in pediatric MS causes lesions in areas of the brain, optic nerves, and spinal cord. A pediatric neurologist can detect these lesions using MRI to help make a diagnosis. Doctors may also look at the antibodies in the blood or cerebrospinal fluid to make a diagnosis between the various pediatric demyelinating diseases.

Treatment for Pediatric MS

Identifying effective disease-modifying therapies and using a comprehensive care approach are both important for treating and delaying disease activity in children.

The treatment approach used for pediatric MS is similar to MS treatment for adults. Many of the therapies used are designed to modulate the immune system. Treatment for someone with pediatric MS will depend on how well they tolerate the therapy and how well the intervention works to improve their outcomes.

Common medications include:

• Interferon beta 1a, found in prescription medications including Avonex and Betaseron
• Glatiramer acetate, found in Glatopa
• Gilenya (fingolimod), the first therapy approved by the U.S. Food and Drug Administration to treat pediatric MS
• Natalizumab, found in medications such as Tysabri
• Rituximab, found in Rituxan, among other medications

Comprehensive care is also integral to successful treatment. Comprehensive care includes getting support from a variety of health care workers, such as:

• Physical therapists
• Speech pathologists
• Psychologists
• Occupational therapists
• Neuropsychologists
• Social workers

Places such as MS centers can make accessing comprehensive care simple and convenient.

Prognosis and Outlook for Pediatric MS

Children with MS tend to have more cognitive symptoms, but working closely with a pediatric neurologist and neuropsychologist may help identify deficiencies early.

The physical symptoms of MS tend to progress more slowly in children compared to adults with MS. Some individuals with the relapsing-remitting form of pediatric MS will go on to develop SPMS later in life.

Overall, the variety of treatment options and the skill of MS centers allow for a positive outlook for people with pediatric MS. As experts learn more about the disease, the CNS, and the immune system, they may develop better treatments to improve the quality of life for people with pediatric MS.

Talk With Others Who Understand

MyMSTeam is the social network for people with MS and their loved ones. On MyMSTeam, more than 165,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Do you have pediatric MS in your family? Share your experience in the comments below, or start a conversation by posting on MyMSTeam.