Pediatric Multiple Sclerosis

This chapter reviews the current understanding of the clinical features, natural history, pathobiology, differential diagnosis, investigations, and treatment of multiple sclerosis (MS) in children. The clinical diagnosis of MS in children requires evidence of recurrent, acquired demyelination, separated in location within the central nervous system (CNS), and disseminated over time. A polysymptomatic presentation is more common in younger patients, whereas a monosymptomatic presentation is more common in adolescents and adults. Clinical care paradigms, therapeutic trials, and pediatric MS-specific outcome measures are urgently needed. The onset of MS in childhood or adolescence occurs during the key formative academic and social years. The long-term prognosis of pediatric-onset MS is largely determined by the risk for development of secondary progressive disease (SPMS) and by the rate of accrual of physical and cognitive disabilities. Factors associated with an increased risk of disability or disability progression in children with MS is tabulated. The role of environment factors, hormonal factors, vitamin D, and vaccinations in MS are also discussed. Diagnoses and investigations to consider in a child with possible CNS demyelination are tabulated. The management of SPMS remains largely symptomatic and supportive. Few children reach this stage of the MS disease process during their childhood.