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Pediatric multiple sclerosis

Nature Reviews Neurology volume 5, pages 621–631 (2009)Cite this article

Abstract

Pediatric multiple sclerosis (MS) accounts for up to 5% of all MS cases. Work conducted over the past 5 years has provided new information about the treatment, pathogenesis, demographics, and natural history of this disorder. Genetic and environmental factors seem to exert critical influences on its development. Clinical, MRI and laboratory data from prepubertal and postpubertal children suggest differences between the immune response and/or CNS environment in younger compared with older children and adults with MS. Randomized, controlled treatment trials for pediatric MS have not yet been performed, but therapies used in adult MS have been evaluated in this population, and their use seems to be safe. This article provides a comprehensive review of current knowledge regarding pediatric MS, highlighting new advances in the field.

Key Points

  • Pediatric multiple sclerosis (MS) represents ∼3–4% of all cases of MS

  • In North America, greater diversity in ethnicity, race and ancestry is observed among individuals with pediatric MS than among adults with MS, possibly reflecting changing demographic trends

  • Studies have suggested environmental influences on pediatric MS susceptibility, including Epstein–Barr virus and exposure to cigarette smoke

  • Acute disseminating encephalomyelitis must be differentiated from MS and is seen more commonly in children than in adults

  • New MRI criteria will, hopefully, help to discriminate pediatric MS from acute disseminated encephalomyelitis

  • Currently available first-line therapies for adults with MS seem to be safe and well tolerated in pediatric MS

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Figure 1: Diagnostic algorithm of pediatric onset demyelinating disorders.
Figure 2: Brain MRI scans of young patients with multiple sclerosis.

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Acknowledgements

Désirée Lie, University of California, Orange, CA is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. Pediatric Multiple Sclerosis Center of the Jacobs Neurological Institute, University at Buffalo, The State University of New York, Buffalo, NY, USA

    E. Ann Yeh

  2. Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA, USA

    Tanuja Chitnis

  3. National Pediatric Multiple Sclerosis Center, Stony Brook University Medical Center, Stony Brook, NY, USA

    Lauren Krupp

  4. Center for Pediatric Onset Demyelinating Disease, Children's Hospital of Alabama and University of Alabama at Birmingham, Birmingham, AL, USA

    Jayne Ness

  5. UCSF Regional Pediatric Multiple Sclerosis Center, University of California, San Francisco, CA, USA

    Dorothée Chabas & Emmanuelle Waubant

  6. Mayo Clinic Pediatric Multiple Sclerosis Center, Rochester, MN, USA

    Nancy Kuntz

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Yeh, E., Chitnis, T., Krupp, L. et al. Pediatric multiple sclerosis. Nat Rev Neurol 5, 621–631 (2009). https://doi.org/10.1038/nrneurol.2009.158

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