What is multiple sclerosis in children?
Multiple Sclerosis in Children is a disorder of the central nervous system. This means that it affects the brain and spinal cord. It is an autoimmune disease as well as inflammatory – meaning that white blood cells, which protect against infection, enter the nervous system, and cause damage. The damage occurs because the myelin sheath, the protective covering of nerves, is stripped of antibodies produced by the immune system. (This is called demyelination). Multiple sclerosis is a long-term disease that can happen to anyone.
Multiple sclerosis begins in children or teenagers. About 98% have relapsing and migratory MS, versus 84% of adults with MS. This means that symptoms come and go (relapse and remission). When symptoms disappear, the disease can still progress. This condition may also be called pediatric multiple sclerosis (POMS), early MS, or juvenile MS. Relapses seem to occur more often in children and teens. This group appears to recover from neurological disability more quickly but is at increased risk of cognitive difficulties that can affect schoolwork.
Symptoms of multiple sclerosis in children
MS symptoms depend on which nerves are affected. Because myelin damage is intermittent and can affect any part of the central nervous system, symptoms of MS are unpredictable and vary from person to person. In children, Multiple sclerosis is often the relapsing and dormant type. This means that the disease alternates between relapses, in which a person appears new symptoms, and calm, where there are only mild or no symptoms.
Attacks can last from days to weeks, and remission can last for months or years. Ultimately, the disease can progress to permanent disability. Most symptoms of multiple sclerosis in children are the same as in adults, include:
- Tingling and numbness
- Eye problems, including vision loss, pain with eye movement, and double vision
- Balance problems
- Difficulty walking
- Spasticity (constant muscle contraction)
- Problems with bowel and bladder control
Symptoms such as weakness, numbness, tingling, and vision loss usually occur on one side of the body at a time. Mood disorders occur more frequently in children with MS. Depression is the most common, occurring in about 27 per cent of children with MS. Other frequent causes include:
- Bipolar depression
- Adjustment disorder
- Panic disorder
Almost 30 per cent of children with multiple sclerosis have a cognitive impairment or problem with their thinking. Include the most affected activities:
- Information processing
- Executive functions like planning, organizing, and decision-making
- Attention span
- Speed and coordination performing tasks
Some symptoms appear more frequently in children but rarely in adults. These symptoms:
Causes of multiple sclerosis in children
The cause of multiple sclerosis in children (and adults) is unknown. It is not contagious, and there is nothing that can be done to prevent it. However, there are several things that appear to increase your risk of developing it:
- Genetics/family history: MS is not inherited from the parents, but if a child has certain sets of genes or a parent or sibling has MS, they are more likely to develop it.
- Exposure to the Epstein-Barr virus: This virus may act as a trigger that releases MS in children exposed to it. However, many children are exposed to the virus and do not develop MS.
- Low levels of vitamin D: MS is found more often in people in northern climates where there is less sunlight than around the equator. Our bodies need sunlight to produce vitamin D, so people in northern climates tend to have lower levels of vitamin D. Researchers believe this may imply a link between multiple sclerosis and low vitamin D. Additionally, low vitamin D levels increase the risk of relapse.
- Exposure to smoking: Cigarette smoke, both direct use and passive exposure, has been shown to increase the risk of developing multiple sclerosis.
Evaluation and diagnosis of multiple sclerosis in children
Children who have been diagnosed with MS have a type called relapsing multiple sclerosis. This type of multiple sclerosis in children is characterized by recurrent episodes that cause new or worsening neurological symptoms, followed by periods without new symptoms, called remissions.
At the time of the first attack, it is not always clear whether the diagnosis of MS is appropriate because the relapsing disease has not yet occurred. New relapses or attacks will confirm your child’s diagnosis and provide insight to help their doctors better manage their care.
There is no single diagnostic test for MS. In most cases, MS is diagnosed in a combination of ways. Your child’s health care provider will take a thorough medical history and order tests that may include:
- Neurological examination
- Magnetic resonance imaging to check for lesions in the brain, spinal cord, or optic nerves
- Lumbar puncture to check the cerebrospinal fluid for antibodies and proteins associated with multiple sclerosis
In some patients, the first MRI scan shows multiple lesions so closely aligned with MS that multiple sclerosis in children can be diagnosed after only one clinical attack. While not common, an early diagnosis can provide an important opportunity for early treatment.
Treatment of multiple sclerosis in children
Although there is no cure for multiple sclerosis in children, there are treatments aimed at reducing new lesions and relapses and slowing the progression of the disease:
- Steroids can reduce inflammation and reduce the length and severity of relapses.
- Plasma exchange, which removes antibodies that attack myelin, may be used to treat relapse if steroids do not work or are not tolerated.
Certain symptoms may be treated with other medicines to improve the quality of life. Physical, occupational and speech therapy can also be helpful for children with multiple sclerosis.
Close follow-up of multiple sclerosis in children is vital to long-term outcomes, and this is provided at the CHOP Children’s Clinic with Multiple Sclerosis and Inflammatory Neurological Disorders. We closely follow children for evidence of relapse, and to monitor drug efficacy. Follow-up MRI studies will also be required on a regular basis, and we will personally review these images during clinic visits.
Multiple sclerosis in children is a chronic condition that must be dealt with throughout life. The course of the disease is difficult to predict and varies from person to person. Some have long periods of remission while others have frequent seizures.