Multiple sclerosis in children: Clinical diagnosis, therapeutic strategies, and future directions

Department of Paediatrics, Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
The Lancet Neurology (Impact Factor: 21.9). 11/2007; 6(10):887-902. DOI: 10.1016/S1474-4422(07)70242-9
Source: PubMed


The onset of multiple sclerosis (MS) in childhood poses diagnostic and therapeutic challenges, particularly if the symptoms of the first demyelinating event resemble acute disseminated encephalomyelitis (ADEM). MRI is an invaluable diagnostic tool but it lacks the specificity to distinguish ADEM from the first attack of MS. Advanced MRI techniques might have the required specificity to reveal whether the loss of integrity in non-lesional tissue occurs as a fundamental feature of MS. Although the onset of MS in childhood typically predicts a favourable short-term prognosis, some children are severely disabled, either physically or cognitively, and more than 50% are predicted to enter the secondary-progressive phase of the disease by the age of 30 years. Immunomodulatory therapies for MS and their safe application in children can improve long-term prognosis. Genetic and environmental factors, such as viral infection, might be uniquely amenable to study in paediatric patients with MS. Understanding the immunological consequences of these putative exposures will shed light on the early pathological changes in MS.

Download full-text


Available from: Amit Bar-Or, Jan 17, 2015
  • Source
    • "MTR recovery decreases significantly with age. and adolescence is associated with limited accrual of physical disability in the first 10 years of disease (Bigi and Banwell, 2012; Boiko et al., 2002; Renoux et al., 2007, 2008; Yeh et al., 2009a). Although there may exist several explanations for the preservation of physical function seen in pediatric MS patients, one possible mechanism could be effective repair of lesions. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Children and adolescents diagnosed with multiple sclerosis rarely accrue physical disability early in their disease. This could be explained by greater remyelination in children, a capacity that may be lost in adolescence or early adulthood. Magnetization transfer ratio (MTR) MRI can be used to quantify changes in myelin in MS. We used serial MTR imaging and longitudinal random effects analysis to quantify recovery of MTR in acute lesions and to evaluate MTR changes in normal-appearing tissue in 19 adolescent MS patients. Our objective was to determine whether younger adolescents have a greater capacity for remyelination, and whether this decreases as patients approach adulthood. We detected a significant decrease in MTR recovery between ages 16 and 20 years (p = 0.023), with older subjects approaching typical recovery levels for adult-onset MS. MTR recovery in acute MS lesions decreases with age in adolescents, suggesting loss of remyelination capacity. This may be related to the conclusion of primary myelination, or other developmental factors.
    Clinical neuroimaging 12/2014; 6. DOI:10.1016/j.nicl.2014.09.003 · 2.53 Impact Factor
  • Source
    • "This hospital serves as the referral center in south of Iran. Diagnosis of all types of ADS (MS, ADEM, ON, TM, and Devic disease) was based on the consensus definition for pediatric ADS (5,7). Inclusion and exclusion criteria are summarized in Table 1 (8). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Incidence of CNS acquired demyelinating syndrome (ADS), especially multiple sclerosis (MS) in children, appears to be on the rise worldwide. The objective of this study was to determine prevalence, clinical presentation, neuroimaging features, and prognosis of different types of ADS in Iranian children. Materials & methods: During the period 2002-2012, all the patients (aged 1-18 years) with ADS, such as MS, acute disseminated encephalomyelitis (ADEM), optic neurotic (ON), Devic disease, and transverse myelitis (TM), referred to the pediatric neurology ward, Nemazee Hospital, Shiraz University of Medical Sciences, were included in this study. Demographic data, clinical signs and symptoms, past and family history, preclinical findings, clinical course, and outcome were obtained. Results: We identified 88 patients with ADS in our center. The most prevalent disease was MS with 36.5% (n=32), followed by AEDM 26.1% (n=31), ON 17% (n=13), TM 15.9% (n=14), and Devic disease 4.5% (n=4). MS, ON, TM were more common among females while ADEM was more common in males. Children with ADEM were significantly younger than those with other types of ADS. Family history was positive in 10% of patients with MS. Previous history of recent infection was considerably seen in cases with ADEM. Clinical presentation and prognosis in this study was in accordance with those in previous studies on children. Conclusion: In this study, the most common type of ADS was MS, which was more common in female and older age cases. ADEM was more common in male and younger children. ADEM and ON had the best and Devic disease had the worst prognosis.
    Iranian Journal of Child Neurology 02/2014; 8(2):18-23.
  • Source
    • "In subjects older than 10 years of age and adolescents, females predominate from 2.1 : 1 to 3 : 1, respectively. However, for those younger than 10 years of age, the female-to-male ratio ranges from 0.8 : 1 in children younger than 6 years of age to 1.6 : 1 in patients between 6 and 10 years of age [12]. Unlike the adult population, in whom MS usually affects non-Hispanic whites, pediatric MS shows greater racial and ethnic variability in North America. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Multiple sclerosis (MS), a chronic inflammatory autoimmune disease of the central nervous system (CNS) commonly diagnosed in adults, is being recognized increasingly in children. An estimated 1.7%-5.6% of all patients with MS have clinical symptoms before reaching the age of 18 years. In comparison with adults, the diagnosis of MS in children can be more difficult, being dismissed or misdiagnosed as other clinical disorders. Although adults and children share basic aspects of the disorder, children have distinctive clinical features, neuroimaging, laboratory, and courses of the disease. The 2010 McDonald criteria have simplified the requirements for establishing the diagnosis of MS and have been proposed to be applicable for the diagnosis of pediatric MS, mainly in children 12 years and older. This paper describes the distinctive features of common pediatric demyelinating disorders, including MS, and summarizes the most recent advances based on the available literature.
    11/2013; 2013(3):673947. DOI:10.1155/2013/673947
Show more