Pediatric Multiple Sclerosis

Pediatric Multiple Sclerosis

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Multiple Sclerosis (MS) is an autoimmune disorder in which the body’s immune system mistakenly attacks the central nervous system, with resulting damage mostly in the brain, optic nerve and spinal cord. While most cases of MS start in adulthood, often, the onset is before the age of 18. While many of the risk factors for pediatric MS have been identified, no specific cause has been found.

If untreated, MS can cause vision loss, weakness, numbness and paralysis of the arms and legs, and loss of bowel or bladder control. Patients can suffer relapses over time with ongoing inflammation leading to disability over time. Once diagnosed, patients will be offered therapy to prevent future attacks.

While MS is rare in children, the interdisciplinary team of doctors and medical professionals in neurology and rehabilitation at Children’s Health have the experience to comprehensively diagnose and treat children with this condition. Within the Children’s Health Pediatric Demyelinating Disease Program, patients receive comprehensive care. In addition, we evaluate new treatments to prevent neurologic damage and restore function in children with the condition.

Symptoms

Symptoms

Symptoms of Multiple Sclerosis may include::

  • Pain in the eye
  • Blurry vision and loss of color vision
  • Weakness and numbness in the arms and/or legs
  • Loss of bladder and bowel control
  • Imbalance when walking

Early diagnosis is critically important to assure the most appropriate treatment happens as quickly as possible.

Tests and Diagnosis

Tests and Diagnosis

To diagnose Multiple Sclerosis, your child’s doctor will do a complete physical exam of your child and ask you about past medical events. There are a number of tests that are useful in diagnosing the condition, and your child’s doctor may recommend a combination of:

  • Lab studies including blood tests
  • Imaging studies include MRI (magnetic resonance imaging) of the brain, optic nerves and spine, to search for damage
  • A lumbar puncture to obtain spinal fluid and then test it to see if there is an increased white blood count or protein concentration
  • Optical Coherence Tomography (OCT) to examine the eyes for evidence of damage
Treatments

Treatments

Your child will be cared for by a medical team with experience in treating this rare and complex condition. Treatment is targeted at treating suppressing inflammation and preventing relapses from occurring.

Recovery from relapses usually begins within two to 12 weeks and may take up to two years.

Typical medication therapies during an acute relapse may include:

  • Several days of intravenous corticosteroids such as methylprednisolone, followed by oral corticosteroid treatment and antibiotics
  • Plasmapheresis, a process that removes the antibodies from the blood that attack the immune system

Early rehabilitation is recommended as well as long-term symptom management. For those patients who experience motor deficits, physical therapy will help increase muscle strength and enhance recovery of the nervous system.

For prevention of relapses, the clinic uses a variety of medications that have been FDA-approved for treating adults. While awaiting the completion of pediatric trials for these medications, the team at Children’s has worked with international colleagues to gain comfort relative to the safety and efficacy of these medications for our pediatric population. At this time, the benefits of the following medications appear to justify their use in children even without formal FDA approval:

  • Interferon Beta 1a (Avonex, Betaseron, Extavia, Plegridy, Rebif)
  • Glatiramer acetate (Copaxone)
  • Natalizumab (Tysabri)
  • Fingolimod (Gilenya)
  • Teriflunomide (Aubagio)
  • Dimethyl Fumarate (Tecfidera)
FAQs

FAQs 

What causes Multiple Sclerosis (MS)?

MS is thought to occur when the body’s immune system mistakenly attacks the brain, optic nerve and spinal cord.  

This inflammation damages the myelin (the coating around nerve fibers). The nerve fibers are similar to the copper electrical wires in a home, connecting a light switch to a light bulb. The copper wires are insulated to protect the wire and speed up the transmission of the signal from the switch to the bulb. The wires of your brain and spinal cord are insulated (to protect the wires and speed up signal transduction) and that insulation is called myelin.

What initially triggers the abnormal immune response is unknown, but data suggests that some individuals are genetically predisposed to have an unusual immune response when exposed to certain infections. Beyond this, data does suggest that Vitamin D deficiency is a risk for MS and a risk for more relapses among patients with MS.

What is the outlook for my child with Multiple Sclerosis?

Early diagnosis is critical for recovery. With proper treatment, many children with MS can recover from relapses and future attacks can be prevented.

How common is Multiple Sclerosis?

MS in children is rare, with fewer than 10,000-20,000 children being affected in the United States.

Where can I find a support group?

We will provide you with resources to help both you and your child. The Resources link on this webpage is also a good source for more information about Multiple Sclerosis and support groups.

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