Pediatric Multiple Sclerosis

Abstract

Pediatric multiple sclerosis (MS), defined as MS in patients younger than 18 years, has few unique features, especially in children before the age of 11 years, although many aspects are similar to those described in adult-onset relapsing-remitting (RR) MS patients. The onset is usually with an acquired CNS demyelinating syndrome (ADS). The 2017 McDonald criteria perform well in identifying pediatric patients with MS against those suffering from monophasic demyelination, although special clinical care is needed in patients under 11 years, since the risk of acute disseminated encephalomyelitis is higher in this younger population. Pediatric MS is characterized by a highly active inflammatory demyelinating activity (in terms of relapses and MRI activity), but also by a higher ability to recover from attacks, and to promote repair mechanisms (i.e., remyelination) and neuroplasticity in comparison with patients with an onset of the disease during adulthood. Accordingly, pediatric MS patients take longer time to reach irreversible disability and the secondary progressive stage of the disease, compared to adult-onset MS patients, but they are at risk of becoming disabled in early adulthood, due to their earlier disease onset. Since MS onset in childhood has a negative impact on a developing brain, as evidenced by MRI measures and neuropsychological testing, effective treatments should be started as early as possible. Treatment strategies are similar to those for adult-onset MS patients; however, only some of the currently available drugs have been approved in this MS population and benefits and risks should be carefully weighted.