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.
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.
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:
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.
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.
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.
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:
Comprehensive care is also integral to successful treatment. Comprehensive care includes getting support from a variety of health care workers, such as:
Places such as MS centers can make accessing comprehensive care simple and convenient.
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.
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