Abstract
Pediatric-onset multiple sclerosis (MS) is a predominantly relapsing-remitting neuroinflammatory disorder characterized by frequent relapses and high magnetic resonance imaging (MRI) lesion burden early in the disease course. Current treatment for pediatric MS relies on early initiation of disease-modifying therapies designed to prevent relapses and slow progression of disability. When considering the concept of MS prevention, one can conceptualize primary prevention (population- or at-risk population interventions that prevent the earliest facet of MS pathobiology and hence reduce disease incidence), or secondary prevention (prevention of disease consequence, such as reducing relapse frequency and lesion accrual, enhancing focal lesion repair, promoting CNS resilience against the more global facets of disease injury, and ultimately, preventing progression of neurological disability). Studying the pediatric MS population provides a unique opportunity to explore early-life exposures that contribute to the development of MS including perinatal and environmental risk determinants. Research is ongoing related to targeting these risk factors for potential MS primary prevention. Here we review these key risk factors, their proposed role in the pathogenesis of MS, and their potential implications for primary MS prevention.
Highlights
Multiple sclerosis (MS) is a chronic demyelinating disease affecting the central nervous system that primarily affects adults; 3 to 10% of all patients diagnosed with multiple sclerosis (MS) experience their first demyelinating event prior to the age of 18 [1–3]
The precise etiology of pediatric-onset MS has yet to be identified, it has become increasingly more evident that multiple risk determinants may play a crucial role. Investigating these environmental determinants in the pediatric-onset MS population allows one to evaluate the earliest influences on MS development and pathogenesis in individuals that are temporally closer to the biologic inciting event(s) of the disease
Studying risk determinants in this population eliminates some of the challenges with recall bias, as children are temporally closer to the incident exposures being studied
Summary
Multiple sclerosis (MS) is a chronic demyelinating disease affecting the central nervous system that primarily affects adults; 3 to 10% of all patients diagnosed with MS experience their first demyelinating event prior to the age of 18 [1–3]. Pediatric-onset MS patients face a lower risk for disability within the first 10 years of disease onset, and a longer time from onset to entry into secondary progressive disease compared to adult-onset patients. They develop disability overall at a younger age than when the disease starts in adulthood. Prompt initiation of highly effective disease modifying therapies, reduce relapses and may reduce the reduce relapses and reduce the likelihood of progressive disability
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