Multiple Sclerosis In Children Research Articles

Fatigue, pain interference, and psychiatric morbidity in multiple sclerosis: The role of childhood stress.

Multiple sclerosis (MS) is a progressive, autoimmune disease of the central nervous system that affects nearly one million Americans. Despite the existence of immunomodulatory therapies to slow physical and cognitive disability progression, interventions to ameliorate common symptoms of MS, including fatigue and pain, remain limited. Poor understanding of risk factors for these symptoms may contribute to treatment challenges. In recent years, childhood stress has been investigated as a risk factor for chronic autoimmune conditions including MS; yet remarkably few studies have investigated the relationship between childhood stressors and chronic MS symptoms. Our aim was to examine clusters of stressors and three key features of MS: fatigue, pain interference, and psychiatric morbidity. Cross-sectional data were collected from a sample of People with MS (PwMS) via a national web-based survey that assessed the presence and type of childhood stressors and MS clinical features. Hierarchical block regression was used to assess associations among emotional, physical, and environmental childhood stressors and three clinical features commonly experienced by PwMS. N = 719 adults with MS (aged 21-85) completed the survey. Childhood emotional and physical stressors were significantly associated with overall presence of fatigue (p = 0.02; p<0.03) and pain interference (p<0.001; p<0.001) in adulthood, as well as the magnitude of both outcomes. Environmental stressors (p<0.001), in addition to emotional (p<0.001) and physical (p<0.001) stressors were significantly associated with psychiatric morbidity in PwMS. Childhood stress may predict fatigue, psychiatric morbidity, and pain in adults with MS. Further research is needed to show cause and effect; however, if an association exists, strategies to mitigate the impact of childhood stress could offer new pathways to reduce the severity of these symptoms. Broadly, this work adds to the body of evidence supporting upstream preventive measures to help address the stress on children and families.

Modern neuroimaging criteria for diagnosing multiple sclerosis in children

The article presents a clinical case of multiple sclerosis (MS) in a 10-year-old female patient, the use of one of the advanced magnetic resonance imaging (MRI) techniques, namely proton magnetic resonance spectroscopy (1H-MRS), in the diagnosis of MS. MRI is an integral part of the diagnostic algorithm for patients with multiple sclerosis according to the McDonald criteria, which were last updated in 2017. In addition, MRI allows assessing the course of the disease, serving as a criterion for confirming the aggravation of the pathological process. Although the McDonald criteria are applied in adults, they are also used to diagnose MS in children, and MS in children has its own particularities. The McDonald criteria include traditional (conventional) MRI sequences: T2-weighted images, T1-weighted images, post-contrast T1-weighted images. With the rapid development of MRI, cutting-edge (advanced) MRI techniques have emerged that allow for a better understanding of changes in the brain matter in MS: brain volumetry, magnetization transfer imaging, cortical imaging, diffusion tensor imaging, 1H-MRS, susceptibility-weighted imaging. In particular, 1H-MRS allows us to assess the degree of white matter integrity by detecting increased resonance of myelin breakdown metabolites. The studies have shown that changes in MS have their own specificity, but there is no consensus on this issue. Currently, there are no agreed guidelines that would include advanced MRI techniques, but we believe they will allow us to better understand the course of MS and to predict the development of the disease. This approach will improve the management of MS in both adults and children and quality of their life.

Pretreatment Neurofilament Light Chain Serum Levels, Early Disease Severity, and Treatment Response in Pediatric Multiple Sclerosis.

High disease activity and frequent therapy failure in pediatric multiple sclerosis (MS) make prognostic biomarkers urgently needed. We investigated whether serum neurofilament light chain (sNfL) levels in treatment-naive pediatric patients with MS are associated with early disease severity and indicate treatment outcomes. A retrospective cohort study of patients seen in the Göttingen Center for MS in Childhood and Adolescence, Germany. Inclusion criteria were MS diagnosis according to the McDonald criteria, MS onset <18 years, and available pretreatment serum sample. sNfL levels were analyzed using a single-molecule array assay. Associations with clinical and MRI evidence of disease severity at sampling were evaluated using the Spearman correlations and nonparametric tests for group comparisons. Correlations between pretreatment sNfL and annualized relapse and new T2 lesion rate on first-line therapy, and odd ratios for switch to high-efficacy therapy were assessed. A total of 178 patients (116 women [65%]) with a mean sampling age of 14.3 years were included in the study. Pretreatment sNfL levels were above the ≥90th percentile reported for healthy controls in 80% of patients (median 21.1 pg/mL) and correlated negatively with age, but no correlation was seen with sex, oligoclonal band status, or body mass index. High pretreatment sNfL levels correlated significantly with a high number of preceding relapses, a shorter first interattack interval, a high T2 lesion count, and recent gadolinium-enhancing lesions. Of interest, sNfL levels reflected more strongly MRI activity rather than clinical activity. Pretreatment sNfL levels also correlated significantly with the relapse rate and occurrence of new/enlarging T2 lesions while on first-line injectable therapy. Odds of future therapy escalation increased from 0.14 for sNfL below 7.5 pg/mL to 6.38 for sNfL above 15 pg/mL. In patients with a recent relapse, higher sNfL levels were associated with poorer recovery 3 months after attack. The results of this study have 3 important implications: First, pretreatment sNfL levels are a valuable biomarker for underlying disease activity in pediatric patients with MS. Second, pretreatment sNfL levels in pediatric patients with MS have a predictive value for the response to first-line therapy and the necessity of future therapy escalation. Third, high sNfL levels during a relapse are associated with poor recovery in this age group.

Features of multiple sclerosis in childhood in the Republic of Tatarstan

Multiple sclerosis (MS) in children and adolescents is a genuine concern of pediatric neurology that specialists in all countries are dealing with. To date, neither the causes of onset nor the individual components of the pathogenesis of the disease have been reliably clarified, and the modern, changing picture of the clinical manifestation of the disease sometimes complicates timely diagnosis even in adult patients. There are more such questions in pediatric MS.Objective: to study the prevalence and clinical features of MS in children in the Republic of Tatarstan.Material and methods. We conducted a survey and data analysis of 128 children and adolescents aged 0 to 18 years inclusive. The examination of patients included neurological examination according to the classical scheme, neuroimaging examination, neurophysiological examination and cerebrospinal fluid examination. The diagnosis was based on the current (as of the time of diagnosis) criteria of McDonald and the International Pediatrics MS Study Group criteria. The severity of the patients' clinical condition was assessed using the Expanded Disability Status Scale (EDSS).Results. MS was diagnosed in 99 cases (77.3%), clinically isolated syndrome – in 10 (7.8%), acute disseminated encephalomyelitis – in 5 (3.9%), bilateral optic neuritis – in two patients (1.6%), disseminated encephalomyelitis – in one case (0.8%); other central nervous system diseases were diagnosed in 11 (8.6%) patients. After a detailed examination, the group “other diseases of the central nervous system” included such conditions as cerebral angiopathy, neurofibromatosis, brain mass, structural focal epilepsy, sequelae of viral encephalitis, and hereditary leukodystrophy. Among the patients, girls aged 15–17 years predominated. Monofocal manifestations were more frequently observed at debut. Moreover, the absolute predominance of the remitting type of course was also noted.Conclusion. The data obtained suggest a predominance of the predominantly remitting course type of MS with a monofocal onset, which is consistent with data from other studies of MS in pediatric practice.

The association between weight during early life and multiple sclerosis onset in a nationwide Dutch birth year cohort

ABSTRACT Background The relationship between being overweight during early life and disease course in multiple sclerosis (MS) is unresolved. We investigated the association between being overweight or obese during early life (childhood and adolescence) and MS case status, age of first symptom onset and onset type in people with MS (pwMS) of the same birth year. Methods We enrolled 363 PwMS and 125 healthy controls (HC) from Project Y, a Dutch population-based cross-sectional cohort study including all PwMS born in 1966 and age and sex-matched HC. The associations between weight during childhood and adolescence (non-overweight vs. overweight or obese) and MS, age at symptom onset and onset type (relapsing vs. progressive) were assessed using logistic and linear regressions. In addition, sex-separated associations were explored. Results Being overweight or obese during childhood (OR = 2.82, 95% CI 1.17–6.80) and adolescence (OR = 2.45, 95% CI 1.13–5.34) was associated with developing MS. Furthermore, being overweight or obese during adolescence was associated with a younger age of onset (β = −0.11, p = 0.041). Of all 47 patients with a primary progressive (PP) onset type, only one patient (2.1%) was overweight or obese during childhood, whereas 45 patients with a relapsing remitting (RR) onset (14.3%) were overweight or obese during childhood (PP vs. RR p = 0.017; PP vs. HC p = 0.676; RR vs. HC, p = 0.015). However, using logistic regression analysis we did not find evidence of a significant association. Conclusion In a nationwide population-based birth year cohort, being overweight or obese during childhood or adolescence is associated with MS prevalence and an earlier age of onset, but does not seem to associate with the type of onset.

Characteristics of the Manifestation of Multiple Sclerosis in Children in Lithuania.

Background and Objectives: Multiple sclerosis (MS) starts quite rarely in childhood, comprising just 3-10% of all diagnosed cases of MS population. The age of onset of the disease may be related to the initial phenotype and the prognosis of MS. The aim of the study is to assess the characteristics of the manifestation of MS in children. Materials and Methods: Two groups of patients were analyzed: those diagnosed with MS in childhood (0 < 18 years of age) and who developed MS in 2005-2021, and those diagnosed in adulthood (≥18 years old). The data were collected from the database of the Lithuanian University of Health Sciences Kauno Klinikos. Results: For the analysis, 105 patients were selected: 35 children (group A) and 70 adults (group B). At the onset of the disease, 62.9% of children and 70.0% of adults experienced visual disturbances (p > 0.05). Isolated symptoms were more common in children (65.7%) as compared to adults (28.6%), p < 0.001. Sensory disorders were more common in adults than in children (p < 0.001). Optic nerve and cerebral hemispheres were the most affected in group A (p < 0.05). During the first year after diagnosis, the median number of relapses in group A was higher (3, range 1-5) as compared to group B (1, range 1-2) (p < 0.001). Recovery time after a relapse was shorter in children as compared to adults (p < 0.001). Oligoclonal bands were found in 85.7% of children and in 98.6% of adults. Oligoclonal bands were less common in the childhood-onset than in the adult-onset group (p = 0.007). Conclusions: The initial symptoms of multiple sclerosis in pediatric patients usually appeared around the age of 16, with a similar frequency in boys and girls, and in most of the childhood cases the initial symptoms were limited to the dysfunction of a single part of the nervous system children usually started with visual disorders, while sensory, coordination and motor disorders were less common. The course of the disease in juvenile patients with MS was more aggressive in the first year as there were more relapses, but the functional impairment recovered faster as compared to adults.

Effects of the ketogenic diet on multiple sclerosis with a focus on the paediatric population

Introduction and Purpose: Multiple sclerosis (MS) is an autoimmune disease that damages the nervous system. Although MS is usually diagnosed in adults, it can also occur in children and adolescents, which presents diagnostic and therapeutic challenges. In recent years, attention has been drawn to the role of diet in alleviating MS symptoms, including in the pediatric population. The ketogenic diet, characterized by low carbohydrate intake, high fat intake, and moderate protein intake, is of interest as an additional therapeutic approach in MS due to its effects on metabolism and reduction of inflammation in the body. Materials and methods: This article reviews the literature on the impact of the ketogenic diet on MS, with particular emphasis on its impact on the course of MS in the pediatric population. Articles were searched by key words, e.g. multiple sclerosis, paediatrics, children, diet, ketogenic diet, in various configurations, in Scopus, Medline, Google Scholar databases. Current state of knowledge: While there are several studies on the effects of the ketogenic diet, including those on MS in children, the results are inconclusive and require further research. Some publications suggest that the ketogenic diet can help alleviate MS symptoms, such as problems with balance and coordination, and improve patients' quality of life. Conclusions: In conclusion, the ketogenic diet may be a promising approach in the treatment of pediatric MS, but requires further research and careful assessment of benefits and risks before its introduction into therapy.

Treatment of multiple sclerosis in children: review of clinical trials

Multiple sclerosis (MS) is a rare neuroinflammatory and neurodegenerative disease that leads to disability and a significant decrease in the quality of life. Over the past decade, the focus of studies of MS disease-modifying therapies (DMT) in adults have significantly changed to highly effective drugs at the early stages of the disease; in pediatric patients, safer, but less effective DMTs are preferred. &#x0D; Today, only two DMTs (fingolimod and teriflunomide) investigated over large phase III studies were approved by regulatory authorities for use in children.&#x0D; In recent years, an increasing number of MS children have been receiving highly effective therapy with drugs such as natalizumab, monoclonal antibodies to CD20, monoclonal antibodies to CD52, and autologous hematopoietic stem cell transplantation. These highly effective methods of treatment provide a significant reduction in the inflammatory activity of the disease compared to the first-line DMTs. Therefore, a number of phase II and III studies are currently conducted to assess their efficacy and safety in MS children.&#x0D; This review is related to the basic treatment of MS in pediatric patients, the study of the efficacy and safety of the currently available drugs.

Clinical and MRI characteristics of multiple sclerosis in Iranian Children and Adolescents.

To determine the clinical and MRI characteristics of multiple sclerosis (MS) in the children and adolescents. In this cross-sectional study, information of 95 MS patients was obtained from the Iranian MS registry. Disease characteristics and imaging data were collected using medical records. Ninety-five patients including 64 female and 31 male subjects with mean age of 13.97±2.4 years (range, 8-18) years were enrolled. The most frequent signs and symptoms were ophthalmic symptoms (n=61, 64.2%), brainstem signs (n=44, 46.3%), cerebellar signs (n=32, 33.6%) and pyramidal signs (n=26, 27.3%). Blurred vision (n=21, 34.4%) was the most common ophthalmic symptom and ataxia (n=24, 75%) the most prevalent cerebellar sign. The most common brainstem signs/symptoms were motor symptoms and vertigo (each n=14, 31.8%) and the most common pyramidal sign/symptom was right upper monoparesis (n=14, 23.3%). Active demyelinating lesions were reported in brain MRI of all patients, mostly appeared as periventricular (n=91, 95.8%) and pericallosal (n=55, 57.9%) lesions. Acute demyelinating spinal lesions were presented in 38 patients (51.3%) with a prominent involvement of the cervical spine (n=33, 86.8%). In our study, the most frequent signs and symptoms were eye symptoms, brainstem signs, cerebellar signs and pyramidal signs, respectively. Moreover, our results showed that MRI plays a critical role in the diagnostic evaluation of MS in children with presence of brain lesions in all patients and spinal lesion in a considerable portion of patients.

Treatment for Children with Multiple Sclerosis

The current treatments for children with multiple sclerosis (MS) was a theme explored in a session at this year’s conference of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), which took place on the 26th–28th October 2022. The speakers shared their insights into the management and clinical consequences of MS in children, and discussed perspectives as to why immunomodulatory treatment is different in children with MS. The session was a Rogier Hintzen Memorial session, dedicated to the memory of the renowned Professor of Neurology from Rotterdam, the Netherlands, whose research focused on MS and neurological disorders of the central nervous system and who was one of the first neurologists to recognise the special needs of children with MS.

Multiple sclerosis in children

This article deals with the clinical features of the course of multiple sclerosis in children. The indices and peculiarities of the disease variations are important characteristic criteria of the general state of health and quality of life in children and adults. The evaluation was carried out on the basis of the data of multiple studies worldwide, which allowed us to draw conclusions on the peculiarities of the course of multiple sclerosis in children and the possibilities of therapeutic approaches for the correction o tfheir state.

Multiple Sclerosis in Children

Multiple sclerosis (MS) is a disease of the brain that renders people unable to do simple day-to-day activities. The cause of MS remains unknown. Doctors hypothesize that there is a “trigger” that makes the immune systems of people with MS overactive, causing injury to their own brains and nerves. Exposure to certain viruses and vitamin deficiencies can increase a person’s likelihood of developing MS. MS causes relatively similar symptoms in children and adults. However, there are specific differences that make the diagnosis, treatment, and outcomes of MS in children unique. Due to these differences, doctors use a special set of criteria (rules) when diagnosing children. There is no cure for MS, but treatments exist to control symptoms and prevent injury to the brain and nerves.

Neutrophil‐to‐Lymphocyte and Platelet‐to-Lymphocyte Ratio in Children with Multiple Sclerosis

Introduction: Multiple sclerosis (MS) is a chronic, inflammatory condition that affects the central nervous system. MS in children often manifests with a relapsing-remitting disease course. Recently, blood neutrophil-to-lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have proposed as a potentially useful markers of clinical outcome in autoimmune/inflamatory diseases. The aim of this study was to clarify the association of NLR and PLR in children with MS. Materials and Methods: Ten patients with MS and 11 healthy controls were enrolled in the study. NLR and PLR were calculated using complete blood count data. Results: The serum NLR and PLR level in relaps period with MS patients were significantly higher than those of remission period with MS patients and controls (P &lt; 0.001). Conclusions: To our knowledge, this is the first study which investigated the role of NLR and PLR as inflammatory biomarkers in patients with MS. Our results demonstrate that NLR and PLR levels are higher in patients with relaps period compared with controls and remission period. NLR and PLR, a simple and easily obtainable parameters, can be used to identify relaps period in MS.

Early predictors of disability in paediatric multiple sclerosis: evidence from a multi-national registry

BackgroundEarly recognition of markers of faster disability worsening in paediatric-onset multiple sclerosis (MS) is a key requisite of personalised therapy for children with MS at the earliest possible time.ObjectiveTo identify...

Pediatric multiple sclerosis on the rise

The development of multiple sclerosis in children provides to have prophylactic and treatment problems, especially if the manifestations of the initial demyelinating episode mirror the acute disseminated encephalomyelitis. This disease which was once considered a rare occurrence has started to show more cases in the last few years. Magnetic resonance imaging seems to be an excellent diagnostic technique but it is limited because of the accuracy to identify acute disseminated encephalomyelitis from the initial bout of multiple sclerosis. Sophisticated magnetic resonance imaging methods could provide the needed precision to identify if the degradation and consistency of non-lesional matter can be differentiated for what happens as a core hallmark of multiple sclerosis. Even though the development of multiple sclerosis in infancy often forecasts a positive short-term outcome, several children become seriously impaired, whether physically or intellectually, and much more than fifty percent are anticipated to reach the secondary-progressive stage of the illness by the age of thirty years. Immunomodulatory treatments for multiple sclerosis and its therapeutic administration in adolescents may enhance long-term outcomes. Environmental and genetic variables, including viral infection, could be especially suitable for investigation in juvenile individuals with multiple sclerosis. Addressing the immunological effects of these exposures should offer insight into the early clinical manifestations and correct diagnosis of multiple sclerosis.

Assessment of Serum 25-hydroxyvitamin D Levels at the First Manifestation of Multiple Sclerosis in Children and Adolescents

Objective: To evaluate serum 25-hydroxyvitamin D levels, demographic features, and anthropometric measurements at the first manifestation of disease in children and adolescents with multiple sclerosis (MS). Methods: This retrospective study included patients with MS and healthy children and adolescents. Children and adolescents whose clinical and radiological findings were compatible with the McDonald 2017 criteria and who had vitamin D results during the first relapse were included. Having an acute or chronic disease was an exclusion criterion for healthy controls. Taking a supplementation including vitamin D is an exclusion criterion for both the MS and control groups. Age, gender, anthropometric measurements, and serum levels of 25-hydroxyvitamin D were extracted from the database. Results: A total of 23 patients (female: 17, 73.9%) and 24 (female: 12, 50.0%) healthy children and adolescents were included. The median ages of the patient group and the control group were 16.33 (2.00), and 15.36 (2.29), respectively. There were no significant differences between the groups in terms of age, gender, weight-standard deviation score (SDS), height-SDS, and body mass index-SDS. Precisely, 87.0% of the patients had a vitamin D deficiency. The mean vitamin D values of the patients and the healthy controls were 12.76±5.52, and 18.75±5.86, respectively. Patients with MS had significantly lower levels of 25-hydroxyvitamin D than healthy controls (p&lt;0.0001). Conclusion: The current study showed that most (87.0%) of the children and adolescents had vitamin D deficiency at the first manifestation of MS. Moreover, the levels of 25-hydroxyvitamin D levels were significantly lower in patients with MS than in the healthy controls.

Machine learning classification of multiple sclerosis in children using optical coherence tomography

Background: In children, multiple sclerosis (MS) is the ultimate diagnosis in only 1/5 to 1/3 of cases after a first episode of central nervous system (CNS) demyelination. As the visual pathway is frequently affected in MS and other CNS demyelinating disorders (DDs), structural retinal imaging such as optical coherence tomography (OCT) can be used to differentiate MS. Objective: This study aimed to investigate the utility of machine learning (ML) based on OCT features to identify distinct structural retinal features in children with DDs. Methods: This study included 512 eyes from 187 (neyes = 374) children with demyelinating diseases and 69 (neyes = 138) controls. Input features of the analysis comprised of 24 auto-segmented OCT features. Results: Random Forest classifier with recursive feature elimination yielded the highest predictive values and identified DDs with 75% and MS with 80% accuracy, while multiclass distinction between MS and monophasic DD was performed with 64% accuracy. A set of eight retinal features were identified as the most important features in this classification. Conclusion: This study demonstrates that ML based on OCT features can be used to support a diagnosis of MS in children.

Retrospective Evaluation of Demographic and Clinical Characteristics of Children with Multiple Sclerosis

Amaç: Bu retrospektif çalışma, multiple skleroz (MS) tanısı ile izlenen çocuk ve adölesan hastaların demografik ve klinik özelliklerini sunmak amacıyla yapılmıştır. Yöntem: Araştırma verileri, 10-25 Aralık 2021 tarihleri arasında İzmir’de bulunan üç hastanede izlenen pediatrik MS tanılı olguların, demografik verileri, başvuru yakınmaları, klinik bulguları veuygulanan tedavileri veri toplama formu ile retrospektif olarak elde edilmiştir. Bulgular: Bu retrospektif çalışmada 40 hastanın verileri incelenmiştir. Hastaların %77,5’i kız, yaş ortalaması 16 yaş ± 2,3 ve ilk atak yaş ortalaması 13,9 yaş olarak bulunmuştur. Hastaların yaklaşık yarısı interferon beta 1a subkutan, %27,5’i glatiramer asetat tedavisi aldığı ve ilaç kullanım sürelerinin ortalama 18 ay olduğu görülmüştür. Hastaların %20’si ise herhangi bir tedavi almamıştır. Tedavi alan hastaların %31,2’si ilaçtan dolayı yan etki yaşamış ve %15,6’sı yan etki nedeniyle tedaviye uyum sağlayamamıştır. Uyum sağlayamayan tüm hastaların tedavileri değiştirilmiştir. Çalışmada 3 olguda ailesel MS hastalığı öyküsü bulunmaktadır. Hastaların %72,5’i ilk ataklarında 3-10 gün intravenöz metilprednizolon tedavisi almış, tedavi alanların yarısından fazlası (%79,2) metilprednizolon tedavisi sonrası tama yakın/tamamen düzelme sağlamıştır. Hastaların %80’i relapsing-remitting MS ve %20’si klinik/radyolojik izole sendrom formundadır. Sonuç: Çocukluk çağında MS hastalığı, kızlarda daha sık ve en sık relapsing-remitting formunda görülmektedir. Çocukluk çağı MS tedavisinde büyük oranda interferon beta 1a ve glatiramer asetat kullanılmaktadır. İmmünomodülatör tedavi ile atak sayısında azalma, genişletilmiş özürlülük durum ölçeği puan ortalamasında düşme ile iyilik hali sağlanabilmektedir.

Differential diagnosis of multiple sclerosis in children

At the onset, multiple sclerosis (MS) in children is characterized by a phase of active inflammation with extensive demyelination of the white matter of the CNS, which often mimics this nosology with a whole spectrum of inflammatory demyelinating diseases such as ADEM, anti-MOG encephalitis, ONMSD. In order to formalize the diagnostic process, the International Pediatric Multiple Sclerosis Study Group (IPMSSG) proposed diagnostic criteria for the main immune-mediated demyelinating diseases of the CNS in children, which, in theory, should simplify the diagnostic search. However, in practice, the range of nosologies in the course of differential diagnosis is much wider and often it is not possible to establish an unambiguous diagnosis in the early stages. The authors analyze their own clinical observations based on a sample of 100 pediatric patients with a referral diagnosis of «MS?» and describe a clinical case of the onset of highly active MS with an assessment of the dynamics of the clinical and paraclinical course of the disease.

Multiple Sclerosis in Children: Differential Diagnosis, Prognosis, and Disease-Modifying Treatment.

Pediatric-onset multiple sclerosis (POMS) is a rare neuroinflammatory and neurodegenerative disease that has a significant impact on long-term physical and cognitive patient outcomes. A small percentage of multiple sclerosis (MS) diagnoses occur before the age of 18 years. Before treatment initiation, a careful differential diagnosis and exclusion of other similar acquired demyelinating syndromes such as anti-aquaporin-4-associated neuromyelitis optica spectrum disorder (AQP4-NMOSD) and myelin oligodendrocyte glycoprotein antibody spectrum disorder (MOGSD) is warranted. The recent 2017 changes to the McDonald criteria can successfully predict up to 71% of MS diagnoses and have good specificity of 95% and sensitivity of 71%. Additional measures such as the presence of T1-weighted hypointense lesions and/or contrast-enhancing lesions significantly increase the accuracy of diagnosis. In adults, early use of disease-modifying therapies (DMTs) is instrumental to a better long-term prognosis, including lower rates of relapse and disability worsening, and numerous FDA-approved therapies for adult-onset MS are available. However, unlike their adult counterparts, the development, testing, and regulatory approval of POMS treatments have been significantly slower and hindered by logistic and/or ethical considerations. Currently, only two MS DMTs (fingolimod and teriflunomide) have been tested in large phase III trials and approved by regulatory agencies for use in POMS. First-line therapies not approved by the FDA for use in children (interferon-β and glatiramer acetate) are also commonly used and result in a significant reduction in inflammatory activity when compared with non-treated POMS patients. An increasing number of POMS patients are now treated with moderate efficacy therapies such as dimethyl fumarate and high-efficacy therapies such as natalizumab, anti-CD20 monoclonal antibodies, anti-CD52 monoclonal antibodies, and/or autologous hematopoietic stem cell transplantation. These high-efficacy DMTs generally provide additional reduction in inflammatory activity when compared with the first-line medications (up to 62% of relapse-rate reduction). Therefore, a number of phase II and III trials are currently investigating their efficacy and safety in POMS patients. In this review, we discuss potential changes in the regulatory approval process for POMS patients that are recommended for DMTs already approved for the adult MS population, including smaller sample size for pharmacokinetic/pharmacodynamic studies, MRI-centered primary outcomes, and/or inclusion of teenagers in the adult trials.