Multiple sclerosis (MS) is characterized by inflammatory demyelination and axonal injury-associated neurodegeneration. Although the majority of MS patients are diagnosed in early to mid-adulthood, pediatric-onset MS is being increasingly recognized. The relapsing-remitting MS (RRMS) phenotype, characterized by acute attacks of neurologic disability (relapses) interspersed with periods of partial or complete clinical remission, accounts for approximately 80% of MS in adults,1 and over 95% of MS in children.2 At some point in the MS disease course, over 90% of RRMS patients will enter the secondary progressive phase of MS (SPMS), in which disease progression occurs with or without discrete relapses. Primary progressive MS, in which disability progression occurs from disease onset, in the absence of clear attacks, occurs in 10% of adult MS patients but is exceptionally rare in children. There are now four disease-modifying therapies approved for use in adults with relapsing MS. There is Class I level evidence for four treatments (three preparations of interferon-beta [IFNβ] and glatiramer acetate).3 All four medications reduce the frequency of clinical relapses by approximately 30%, …