Pediatric MS

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Out of the approximately 400,000 people who live with MS in the US, about 8,000 to 10,000 are children or adolescents. These children are diagnosed with pediatric MS. An additional 10,000 to 15,000 children experience one or more MS-like symptoms that may or may not eventually lead to a diagnosis of MS.

Symptoms of MS can appear in infants as young as 13 months and MS has been diagnosed in children as young as 2 years of age. However, most diagnoses of pediatric MS are made during adolescence in the teenage years.

 

Does diagnosis of MS in children differ from adults?

Currently, the diagnostic criteria used for diagnosing MS in children is the same as for adults. Diagnostic tools include a combination of medical history, neurologic exam, magnetic resonance imaging (MRI), visual evoked potentials, analysis of cerebrospinal fluid, and other tests to exclude differential (other possible) diagnoses.

A challenge arises, however, because other childhood diseases and disorders can have symptoms or characteristics similar to MS. For example, a child may experience a single episode of neurologic symptoms with a condition called acute disseminated encephalomyelitis (ADEM) which typically follows a viral illness or may be the result of a reaction to a vaccine or medication. Also, children may be less likely to report symptoms, such as vision problems or difficulties with balance, which could delay a diagnosis of MS.

 

Are the symptoms of MS similar in children and adults?

The majority of MS symptoms that affect adults are also seen in children. However, children may experience symptoms in a different way than adults. Children tend to have a combination of symptoms during attacks, with the most common including numbness, tingling, weakness, blurred vision, loss of vision, and problems with coordination and balance. As with adults, children can experience cognitive and emotional changes. Cognitive challenges involving attention, problem-solving skills, information-processing speeds, and memory are of particular concern with children due to the impact they may have on school performance. Parents and teachers should be on the lookout for these symptoms and consider a cognitive evaluation (including neuropsychological testing) when symptoms arise.

 

Is the disease course of MS similar in children and adults?

MS in children is most often relapsing-remitting MS (RRMS), a form of MS which involves relapses (exacerbations, attacks, or flare-ups) of increased symptoms followed by periods of total or partial remission. Primary-progressive MS (PPMS) is rare in children. While the majority of adults with RRMS eventually transition to secondary-progressive MS (SPMS), it is not known if this is true for children with RRMS. In general, MS progresses more slowly in children with more frequent but shorter relapses.

 

Are treatments for MS similar for children and adults?

The disease-modifying treatments (DMTs or DMDs) Avonex (interferon beta-1a), Betaseron (interferon beta 1-b), Copaxone (glatiramer acetate), Rebif (interferon beta-1a), and Extavia (interferon beta 1-b) have been shown to slow MS progression and are considered first-line therapies in both children and adults. Although, randomized, controlled trials of these medications have only included participants over the age of 18 years, most experts believe that these medications are safe and well tolerated in children. For children who do not respond to first-line medications, there are a number of other drugs that may be prescribed, including Tysabri (natalizumab) which is often considered a second-line therapy.

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