Pediatric Multiple Sclerosis: Causes, Symptoms, Treatment, Life Expectancy, Outlook, Diagnosis

Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system. Pediatric multiple sclerosis impacts children and teenagers and can be diagnosed through various diagnostic tests and symptom history. The cause of multiple sclerosis is unknown, and there is no cure for the disease as of today. While most people know about multiple sclerosis in adults, not much is known about pediatric multiple sclerosis. Here’s everything you need to know about pediatric multiple sclerosis.

What is Pediatric Multiple Sclerosis?

Multiple sclerosis is a disorder that affects the central nervous system, meaning the spinal cord and the brain.(1,2) It is an autoimmune disease, which means that your own immune system mistakenly starts attacking the protective sheath that surrounds the nerves in the spinal cord and the brain.(3,4,5) This protective sheath is known as myelin, and its primary role is to allow the signal to move smoothly and quickly between the nerves. When this myelin sheath gets damaged, the communication of signals slows down and stops altogether as the disease progresses. This miscommunication or slowed down communication between the nerves is what causes the symptoms of multiple sclerosis.(6,7,8)

When multiple sclerosis gets diagnosed in childhood, it is known as pediatric multiple sclerosis. Just three to five percent of people with multiple sclerosis get diagnosed before they turn 16, and even less than one percent of patients receive the diagnosis before they turn ten.(9,10)

Nearly 98 percent of people with pediatric multiple sclerosis are diagnosed with relapsing-remitting MS as compared to 84 percent of adults with multiple sclerosis.(11) Relapsing-remitting MS is a form of multiple sclerosis in which the symptoms come and go or relapse, and then remit. During relapses of the disease, children or teenagers may end up developing new symptoms, while during the remission phase, they may experience only mild or no symptoms of the pediatric multiple sclerosis.

However, even when the symptoms of pediatric multiple sclerosis disappear, the underlying disease is still able to progress and become worse with time. This condition is sometimes also referred to as pediatric-onset multiple sclerosis (POMS), juvenile multiple sclerosis, or early-onset multiple sclerosis.

It has been observed that relapses of pediatric multiple sclerosis are more common in children and teenagers. Children and teenagers also appear to recover from the neurological disability brought on by this illness faster, but at the same time, they are at a higher risk of developing cognitive difficulties that affect their studies and school life.

Before children hit puberty, the ratio of males to females who develop pediatric multiple sclerosis is near about the same. However, after puberty, the ratio becomes 1 male is to 2 or 3 females. These statistics indicate that sex hormones are likely to play a role in the development of pediatric multiple sclerosis.(12)

What are the Symptoms of Pediatric Multiple Sclerosis?

The symptoms of multiple sclerosis in both adults and children depend on which nerves of the body are affected. Since the damage to the myelin sheath can often be spotty or in parts, it can affect any part of the central nervous system. Due to this, the symptoms of multiple sclerosis vary from person to person and are usually quite unpredictable.(13) The symptoms of pediatric multiple sclerosis can be physically sensory, which involves changes in feeling, or they can be motor, which involves changes in movement. The symptoms may also involve other factors like emotions, thinking, walking, or vision. However, most people only experience a couple of these symptoms, not all of them.

Flares of multiple sclerosis can last for days or weeks, while remission can last for several months to even years. Over time, though, the disease will eventually progress and lead to permanent disability.

Most of the symptoms of pediatric multiple sclerosis are the same as those experienced by adults. These include:

Symptoms like fatigue, tingling, numbness, and vision loss usually affect only one side of the body at a given time.

Children with multiple sclerosis also experience frequent mood disorders, with depression being the most common. It is estimated that nearly 27% of children with multiple sclerosis develop depression.(14) Some of the other mood disorders commonly observed in children with multiple sclerosis include:

Nearly 30 percent of children with multiple sclerosis also experience cognitive impairment or have trouble with their thinking.(15) Some of the affected activities by cognitive impairment include:

  • Information processing
  • Memory
  • Attention span
  • Executive functions like organizing, planning, and decision making
  • Speed and coordination performing tasks

Some symptoms of multiple sclerosis that are mostly observed in children but very rarely seen in adults include:

  • Lethargy
  • Seizures

What are the Causes of Pediatric Multiple Sclerosis?

Not much is known about what exactly causes pediatric multiple sclerosis. However, research indicates that your risk of developing the disease goes up due to certain factors like:

  • Being overweight
  • Having low levels of vitamin D in the blood: Multiple sclerosis is more commonly diagnosed in people who live in colder climates where there is less exposure to sunshine as compared to those who live near the equator. Sunlight is necessary for the body to manufacture vitamin D, which is why people living in colder climates tend to have lower levels of vitamin D. Due to this, researchers believe there is a link between vitamin D deficiency and multiple sclerosis.(16) Additionally, having low levels of vitamin D is also linked to a higher risk of a relapse.
  • Genetics: A child cannot inherit multiple sclerosis from their parents, but if the child has a specific combination of genes, or they have a sibling or parent with the disease, then they are more likely to develop it.
  • Being exposed to environmental toxins like pesticides and even secondhand smoke
  • Being infected by the Epstein-Barr virus, which causes mononucleosis: The Epstein-Barr virus is believed to act as a trigger that sets off multiple sclerosis in children who are at risk of the condition from beforehand. However, not all children who get exposed to the Epstein-Barr virus go on to develop multiple sclerosis.(17)

How is Pediatric Multiple Sclerosis Diagnosed?

Diagnosing multiple sclerosis in children can prove to be challenging due to a number of reasons. The main reason is that many other childhood diseases are also known to cause similar symptoms, making it hard to distinguish. Since multiple sclerosis is very rare in kids and teenagers, it is usually not the first condition that doctors search for.

There is also no specific test for diagnosing multiple sclerosis. Instead, your doctor will various information gathered from your medical history, family history, physical examination, and a variety of other tests to confirm the diagnosis of multiple sclerosis. Simultaneously, other possible causes of your symptoms will also need to be ruled out.

For diagnosing pediatric multiple sclerosis, a doctor needs to first find proof of the condition in both parts of the central nervous system at two different times. This means that a doctor will look for evidence in both the brain and the spinal cord at two different times. A firm diagnosis of multiple sclerosis will only be made after just one episode of MS-related abnormalities is observed on an MRI scan. There should also be evidence of multiple sclerosis present in the spinal fluid sample, and all other causes of the symptoms need to be ruled out.

Some of the tests a doctor typically uses for diagnosing multiple sclerosis include:

  • Medical History and Physical Examination: A doctor will ask questions about the frequency and kinds of symptoms the child is experiencing and also perform a thorough physical and neurological examination.(18)
  • MRI Scan: An MRI scan shows whether any part of your spinal cord and brain have been damaged. The scan can also show if there is any inflammation present in the optic nerve that is located between the brain and the eye. This condition is known as optic neuritis and is associated with causing temporary vision loss in just one eye.(19)
  • Examination of Spinal Fluid: A spinal tap will be carried out for which a doctor will take a sample of the fluid surrounding the spinal cord and the brain. They will check for signs of the disease in this spinal fluid.
  • Optical Coherence Tomography: This diagnostic test takes a picture of the optic nerve and checks to see whether it is thinning. This test is also used to determine if there has been any history of optic neuritis that might not have caused any symptom earlier.
  • Evoked Potentials: This diagnostic test is used to determine how fast the signals are moving through your nerves. In children with multiple sclerosis, these signals will be slow if there is a history of optic neuritis.

Treatment of Pediatric Multiple Sclerosis

While there is no cure for multiple sclerosis, there are many treatments that help reduce the development of new lesions and relapses. These treatments are also focused on slowing down the progression of the disease. These include:

  • Steroids for reducing inflammation and decrease the severity and length of the relapses.
  • Plasma exchange is a treatment that removes the antibodies that are attacking the myelin sheath. This procedure is used to treat a relapse if steroids are not working or have too many side effects.
  • Various medications are used to treat the specific symptoms of pediatric multiple sclerosis and to improve the overall quality of life.
  • Many children with multiple sclerosis find occupational, physical, and speech therapy to be highly useful.

Conclusion: Outlook and Life Expectancy of Pediatric Multiple Sclerosis

Multiple sclerosis is a progressive and chronic disease, and there is no cure for it. However, this is not a fatal condition and does not generally have much effect on one’s life expectancy. Most children with multiple sclerosis go on to progress from having relapsing-remitting MS to developing an irreversible disability. It has been observed that the disorder tends to progress more slowly in teenagers and children, through major impairment can develop around ten years after. However, because pediatric multiple sclerosis begins at a younger age, children begin to need permanent assistance about ten years earlier in life as compared to those who have adult-onset of the disease.(20)

Children also experience more frequent flare-ups than adults, especially in the first couple of years after being diagnosed. Nevertheless, they also recover from these flare-ups and proceed into remission faster than those who are diagnosed as adults.

Pediatric multiple sclerosis cannot be prevented or cured. Neither is it contagious. However, treating the symptoms, maintaining a healthy life, and addressing any mental and emotional challenges, will help kids and teenagers, along with their families, live a better quality of life.

References:

  1. Ferguson, B., Matyszak, M.K., Esiri, M.M. and Perry, V.H., 1997. Axonal damage in acute multiple sclerosis lesions. Brain: a journal of neurology, 120(3), pp.393-399.
  2. Sospedra, M. and Martin, R., 2005. Immunology of multiple sclerosis. Annu. Rev. Immunol., 23, pp.683-747.
  3. Bernard, C.C. and de Rosbo, N.K., 1992. Multiple sclerosis: an autoimmune disease of multifactorial etiology. Current opinion in immunology, 4(6), pp.760-765.
  4. Wootla, B., Eriguchi, M. and Rodriguez, M., 2012. Is multiple sclerosis an autoimmune disease?. Autoimmune diseases, 2012.
  5. Baker, H.W.G., Balla, J.I., Burger, H.G., Ebeling, P. and Mackay, I.R., 1972. Multiple sclerosis and autoimmune diseases. Australian and New Zealand Journal of Medicine, 2(3), pp.256-260.
  6. Dendrou, C.A., Fugger, L. and Friese, M.A., 2015. Immunopathology of multiple sclerosis. Nature Reviews Immunology, 15(9), pp.545-558. Bmcneurol.biomedcentral.com. 2020. [online] Available at: <https://bmcneurol.biomedcentral.com/track/pdf/10.1186/s12883-018-1026-3> [Accessed 23 October 2020].
  7. Alroughani, R. and Boyko, A., 2018. Pediatric multiple sclerosis: a review. BMC neurology, 18(1), p.27.
  8. Yeh, E.A., Chitnis, T., Krupp, L., Ness, J., Chabas, D., Kuntz, N., Waubant, E. and US Network of Pediatric Multiple Sclerosis Centers of Excellence, 2009. Pediatric multiple sclerosis. Nature Reviews Neurology, 5(11), p.621.
  9. Krupp, L.B., Banwell, B. and Tenembaum, S., 2007. Consensus definitions proposed for pediatric multiple sclerosis and related disorders. Neurology, 68(16 suppl 2), pp.S7-S12.
  10. Goldenberg, M.M., 2012. Multiple sclerosis review. Pharmacy and Therapeutics, 37(3), p.175.
  11. Tintoré, M. and Arrambide, G., 2009. Early onset multiple sclerosis: the role of gender. Journal of the neurological sciences, 286(1-2), pp.31-34. Venkateswaran, S. and Banwell, B., 2010. Pediatric multiple sclerosis. In Blue Books of Neurology (Vol. 35, pp. 185-205). Butterworth-Heinemann.
  12. Skokou, M., Soubasi, E. and Gourzis, P., 2012. Depression in multiple sclerosis: a review of assessment and treatment approaches in adult and pediatric populations. International Scholarly Research Notices, 2012.
  13. Julian, L., Serafin, D., Charvet, L., Ackerson, J., Benedict, R., Braaten, E., Brown, T., O’Donnell, E., Parrish, J., Preston, T. and Zaccariello, M., 2013. Cognitive impairment occurs in children and adolescents with multiple sclerosis: results from a United States network. Journal of child neurology, 28(1), pp.102-107.
  14. Sintzel, M.B., Rametta, M. and Reder, A.T., 2018. Vitamin D and multiple sclerosis: a comprehensive review. Neurology and therapy, 7(1), pp.59-85.
  15. Alotaibi, S., Kennedy, J., Tellier, R., Stephens, D. and Banwell, B., 2004. Epstein-Barr virus in pediatric multiple sclerosis. Jama, 291(15), pp.1875-1879.
  16. MacAllister, W.S., Christodoulou, C., Milazzo, M. and Krupp, L.B., 2007. Longitudinal neuropsychological assessment in pediatric multiple sclerosis. Developmental neuropsychology, 32(2), pp.625-644.
  17. Callen, D.J.A., Shroff, M.M., Branson, H.M., Lotze, T., Li, D.K., Stephens, D. and Banwell, B.L., 2009. MRI in the diagnosis of pediatric multiple sclerosis. Neurology, 72(11), pp.961-967.
  18. Renoux, C., Vukusic, S., Mikaeloff, Y., Edan, G., Clanet, M., Dubois, B., Debouverie, M., Brochet, B., Lebrun-Frenay, C., Pelletier, J. and Moreau, T., 2007. Natural history of multiple sclerosis with childhood onset. New England Journal of Medicine, 356(25), pp.2603-2613.

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