Pediatric Multiple Sclerosis: Clinical Presentation, Diagnosis and Management

Abstract

Pediatric onset multiple sclerosis (POMS) is a rare but important diagnosis, as it confers a significant risk of long-term neurologic morbidity without timely diagnosis and initiation of effective disease-modifying therapy. Most children with MS are adolescents, and risk factors include female sex, EBV exposure, hypovitaminosis D, and obesity. Clinically, POMS manifests almost exclusively as relapsing remitting MS. While the pathophysiology, clinical presentation, and radiographic findings data are similar to those of adult MS, children tend to have more active inflammatory courses and more destructive lesions. Fingolimod is the only FDA-approved treatment for pediatric MS, but a variety of other effective disease modifying therapies are also used. In addition to suppressing relapses and new lesion formation, it is also necessary to address symptoms such as fatigue, depression, and cognitive issues that compromise academic performance and quality of life for these children. In this chapter, we review the epidemiology, clinical presentation, diagnosis, and management of pediatric multiple sclerosis. We also address a number of special considerations in the pediatric population.