Pediatric MS: Multiple sclerosis in children

According to the National Multiple Sclerosis Society, nearly 1 million adults in the United States have MS.

The number of children with MS is much smaller, with the same organization estimating that there are less than 5,000 people younger than 18 who have MS in the United States and less than 10,000 worldwide.

MS in children and teens is similar to MS in adults. However, there are some differences:

• Compared with adults, children likely experience more frequent relapses — during which symptoms worsen significantly — one study suggests.
• Another study reports that children with MS take more time to reach motor disability milestones than adults with MS.
• However, the same study notes that children with MS still reach the disability milestones at a younger age than people who receive a diagnosis in adulthood.
• According to one study, lesions on the brain that result from MS were more inflamed in children with the disease, compared with adults.
• Children and juveniles with MS tend to experience difficulties with functions such as memory, concentration, and language within about two years of their diagnosis.
• The same research indicates that young people may also experience fatigue and depression during this time frame.

Learning about these characteristics can help children, parents, and caregivers better understand the disease and its progression.

The medical community is still unsure about what causes a person to have MS.

Some potential risk factors include:

• family history
• obesity
• vitamin D deficiency
• the onset of puberty in females
• exposure to the Epstein-Barr virus
• exposure to secondhand smoke

Symptoms of pediatric MS are similar to those in adults. Some common symptoms include:

• weakness
• difficulty walking
• difficulty with bowel and bladder control
• changes in vision
• tremors
• muscle spasms
• tingling or numbness in the limbs, face, and other parts of the body
• changes in sensory perception

In addition, young children are more likely to experience cognitive and coordination problems.

Treatments for MS in adults and children do not vary greatly, and a doctor may prescribe several of the same medications for both age groups.

One of the first treatments that healthcare providers typically try involves using interferon beta 1-alpha or glatiramer acetate. These are self-injected medications that help limit or eliminate symptoms associated with MS.

The Food and Drug Administration (FDA) has not approved either interferon beta 1-alpha or glatiramer acetate for use in children, but doctors often recommend these medications for off-label use.

When first-line therapies do not work or are not sufficiently effective, a doctor may recommend a different disease modifying treatment.

In 2018, the FDA approved the use of fingolimod, an oral medication, for children aged 10 or older who had relapsing-remitting MS.

The FDA first approved this drug for use in adults with the condition in 2010. It helped increase the amount of time between relapses and reduced the activity of the disease.

Researchers are looking into additional oral medications for children and adolescents. For example, some are investigating MS-related uses of rituximab, a medication that can help treat autoimmune disorders in children.

In addition to disease modifying treatment, doctors may prescribe other medications to control certain symptoms, such as pain or spasms.

Children and teenagers who have MS may also benefit from therapy that addresses mental health. MS is a lifelong condition and symptoms tend to get worse over time. This can be a source of anxiety and may lead to depression.

It is important for parents and caregivers to encourage children and teens to speak about any fears and concerns and to help provide supportive therapy when necessary.

There is no MS diet. However, children with MS should eat a balanced diet that is healthy. Some experts recommend that people with MS eat a diet that is low in fat and high in fiber. Some people have made personal claims about their diet helping their MS symptoms.

There is some evidence that a diet low in saturated fat and supplemented with Omega-3 from flaxseed oil or fatty fishes and Omega-6 from sunflower seed oil is beneficial for people with MS. If a person with MS adds vitamin B and vitamin D to their diet, it could be beneficial, but more research is needed.

MS is not easy to diagnose. First, the doctor will ask about symptoms, perform an exam, and consider the child’s family history.

To meet the criteria for MS, a child must have experienced at least two discrete demyelinating events. These events indicate that there has been damage in separate areas of the central nervous system at different times.

In addition, a pediatrician needs to rule out other conditions that could be the source of any symptoms. They may order tests to help with this part of the diagnosis.

Anyone concerned about potential symptoms of MS in a child or teen should speak to a pediatrician.

MS symptoms are the same in children and adults. While there is no cure for MS, treatments focus on reducing or eliminating the symptoms and limiting the number of relapses that a child or adult experiences.

If a child reports any symptoms of MS, including numbness, weakness, or changes in muscular control, it is important to consult a pediatrician.

The pediatric MS prognosis is a relapse of the disease in 97% of people who were diagnosed before the age of 18. There is a high frequency of relapse in pediatric patients after the first few years of the disease onset.

Pediatric MS patients often have a longer period between their first attack and physical disability compared to adults. People with pediatric MS may experience cognitive and academic impairment.

Supporting the mental health of children and teens with MS is crucial. Counseling can help.