Multiple sclerosis (MS) is occasionally diagnosed in children and teens, though it occurs more often in adults. According to the latest estimates, around 9000 children in the United States have MS, and some studies report that 2-5% of MS patients start experiencing symptoms before age 18.

Although the challenges related to MS are strikingly similar in both children and adults, children can experience unique problems associated with the disease.

Symptoms of MS in children

Relapsing-remitting MS (RRMS) is the most commonly diagnosed form of MS in children. RRMS presents clearly defined relapses and remissions without the occurrence of new symptoms or disease progression.

While MS symptoms experienced by children are fairly similar as those that occur with MS adults, some symptoms occur more frequently in the pediatric MS population, including:

• Irritability
• Malaise
• Depression
• Anxiety
• Mild fever
• Lethargy
• Seizures
• Tremors

Every child is different, so each child with MS will experience a different range of symptoms and level of severity.

Relapses are more frequent in children than adults, and though the disease course in children is slower, accumulation of disability is more significant. The psychosocial consequences of the disease in children can affect academic performance as well as friendships and self-image.

Additionally, MS can affect memory and thinking, thus having a direct impact on a child’s educational performance. MS in children often affects the entire family as it can affect mood, communication, interactions, and relationships.

Diagnosis of MS in children

MS diagnosis in children is more challenging than it is for adults because of the frequency of other health conditions that affect children with symptoms similar to MS. Since MS is not common in children, pediatricians are likely to overlook the condition. Children with MS will need multidisciplinary care teams including pediatricians and MS experts.

Management of pediatric MS

According to some studies, natalizumab can be safely used in children who fail to respond to other treatment modalities. More extensive clinical trials are required to determine the effectiveness of DMTs in children, teens, and adolescents.Many of the FDA-approved disease-modifying therapies (DMTs) used to treat MS in adults are also found to be well tolerated in children with MS, though they are not specifically licensed for use in children.

Receiving assistance for childhood MS in other forms is also very important. The child’s family needs to be educated about the condition and its symptoms, and they need to have an open discussion with their doctor regarding any concerns.

Other management and coping techniques for MS include:

• Meeting people who are in the same situation in online support groups and forums
• Talking to qualified individuals at the MS Society helpline
• Reaching out to healthcare and social service professionals for support of the child as well as the family
• Learning about the financial benefits that can be claimed on the child’s behalf to mitigate the financial impact of MS

Summary

Although the exact causes of MS in children is relatively unknown, it is believed that children with a genetic predisposition are more prone to the disease. MS greatly varies from one child to another, so it is hard to predict the level of disability in each child.

It is reassuring to know that pediatric MS transitions to secondary progressive MS at a much slower rate compared to adults. While in adults 50% of progression can happen within ten years of diagnosis, MS in children apparently takes about 23 years for 50% progression.

References

• http://www.nationalmssociety.org/What-is-MS/Who-Gets-MS/Pediatric-MS
• https://www.mssociety.org.uk/what-is-ms/types-of-ms/ms-in-children
• https://mssociety.ca/en/pdf/PediatricMSQAEN.pdf
• http://www.childrenshospital.org/conditions-and-treatments/conditions/multiple-sclerosis-ms