Pediatric multiple sclerosis


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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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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Correspondence to E. Ann Yeh.

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The authors, the Journal Editor H. Wood and the CME questions author D. Lie declare no competing interests.

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Yeh, E., Chitnis, T., Krupp, L. et al. Pediatric multiple sclerosis. Nat Rev Neurol 5, 621–631 (2009).

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