5 Treatment Options for Pediatric Multiple Sclerosis

Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system, meaning the spinal cord and the brain. This disorder affects the immune system of the body, causing it to attack and damage the protective covering of the nerves, known as the myelin sheath. The resulting nerve damage from this disrupts the communication between the brain and the rest of the body. While multiple sclerosis is typically a disease that affects adults, it sometimes also affects children. In children, it is known as pediatric multiple sclerosis.

Treatment Options for Pediatric Multiple Sclerosis

While there is no cure for multiple sclerosis, there are a variety of treatments that can help you manage the condition. Certain treatments for pediatric multiple sclerosis help slow down the progression of the disease, while others work to alleviate the symptoms or complications. Here are some of the treatment options for pediatric multiple sclerosis.

1. Disease-Modifying Therapies (DMTs) for Pediatric Multiple Sclerosis

Many doctors prefer to begin treating pediatric multiple sclerosis with disease-modifying therapies or DMTs.(1,2) Disease-modifying therapies are a class of medication that helps slow down the progression of multiple sclerosis. These medications will also help prevent relapses, which is a flare-up or when your child develops new symptoms.(3) As of today, the US Food and Drug Administration (FDA) has approved 17 different types of disease-modifying therapies that can be used for treating multiple sclerosis in adults. However, there is only FDA-approved disease-modifying medication for treating multiple sclerosis in children who are aged 10 years and above.(4,5)

This disease-modifying medication is known as fingolimod (brand name Gilenya), and it is specially approved for the treatment of the relapsing form of pediatric multiple sclerosis.(6,7)

It is essential to know that the FDA has not approved any other disease-modifying drug for the treatment of pediatric multiple sclerosis in children who are younger than 10 years old. Nevertheless, a doctor may still prescribe a disease-modifying therapy for a child who is younger than 10. This scenario is known as ‘off-label use,’ and many doctors prescribe it if they feel the medication may help.

Treating pediatric multiple sclerosis at an early stage with disease-modifying therapies can help improve the long-term outlook of the disease. However, there are several side effects associated with the use of these drugs.(8)

This is why when a child is prescribed disease-modifying therapies, the doctor will monitor them closely for side effects. If the child does not respond well to a certain type of drug, they will be switched to another type of disease-modifying therapy.

2. Symptomatic Medications for Pediatric Multiple Sclerosis

Apart from drug modifying therapies, there are other medications also available for treating the various symptoms and certain complications of multiple sclerosis. Depending on your child’s treatment requirements, the doctor may prescribe different medications for treating one or more symptoms like:

If your child suddenly experiences new symptoms during a relapse, their doctor may opt for treating them with a short course of intravenous corticosteroids. This will also help boost the recovery speed from the relapse.(9,10)

If your child develops certain complications or new symptoms of multiple sclerosis, it is of utmost importance that you inform their medical team at the earliest. Their doctor needs to know about any new development to ensure that they are getting the best treatment possible for their symptoms.

3. Rehabilitation Therapy for Pediatric Multiple Sclerosis

Pediatric multiple sclerosis is known to affect a child’s cognitive and physical functioning in many ways. Rehabilitation therapy can help your child learn to adapt to their changing needs and how to manage other types of day to day activities. Here are some of the options doctors may recommend for your child:

  • Occupational Therapy (OT): The goal of occupational therapy is to help your child learn new techniques for completing daily activities independently but safely. An occupational therapist will work with your child to develop certain energy conservation techniques and learn how to use various adaptive tools. At the same time, you will learn how to modify your home and possibly even the school environment to make it more accessible to your child.(11)
  • Physical Therapy (PT): Physical therapy is required for children as the disease progresses. Physical therapy focuses on teaching children exercises that strengthen and stretches their muscles, builds their coordination and balance, and also enhances their mobility. If your child is already using a mobility aid like a wheelchair or a walker, their physical therapist will help them learn how best to use it.(12)
  • Cognitive rehabilitation: A mental health professional like a psychologist will use cognitive rehabilitation techniques to help the child improve and maintain their memory and thinking skills.
  • Speech-Language Therapy (SLT): Speech-language therapy involves a pathologist or a speech-language therapist helping your child cope up with problems they might be having with swallowing or speaking.(13)

4. Psychological Counseling for Pediatric Multiple Sclerosis

Dealing with multiple sclerosis is a stressful and challenging process, not just for the child but for the entire family. Apart from the many symptoms and potential complications of multiples sclerosis, your child might be experiencing feelings of depression, anxiety, anger, or grief.

It is also common for children with multiple sclerosis to experience mental health or emotional challenges. To help your child cope, their doctor may refer them to a mental health professional for diagnosis and further treatment. Their doctor or the mental health doctor may also recommend that they need additional behavioral counseling, medication, or sometimes both.

Often the family members also find it challenging to cope with the emotional and financial challenges of managing a child with multiple sclerosis. You may also find that it helps to receive some professional help. Receiving some emotional support may enable you to better support your child.(14)

5. Lifestyle Changes for Pediatric Multiple Sclerosis

Multiple sclerosis is a progressive disease, meaning it will get worse as time progresses. This is why it is essential that you make certain lifestyle changes to help your child and your family manage the condition. Your child’s medical team is also going to recommend certain changes in their lifestyle. These include:

  • Regular exercise routine
  • Healthy and well-balanced diet
  • Healthy sleeping habits
  • A healthy amount of leisure activities
  • Regular study habits

While there are no specific dietary restrictions to be followed for multiple sclerosis, but your child will benefit from eating a nutritious and well-balanced diet that includes a lot of fresh fruits and vegetables. Most of the lifestyle changes recommended for managing pediatric multiple sclerosis are the same habits that support overall good health.

Conclusion

Seeking early treatment if you suspect your child may have multiple sclerosis will help your child take care of their health and improve their quality of life. Depending on the exact health needs of your child, the medical team may recommend disease-modifying therapies, symptomatic medications, lifestyle changes, rehabilitation therapies, or other treatments. Your child’s doctor will be the best person to discuss the potential benefits and risks of the various treatment options.

References:

  1. Venkateswaran, S. and Banwell, B., 2010. Pediatric multiple sclerosis. In Blue Books of Neurology (Vol. 35, pp. 185-205). Butterworth-Heinemann.
  2. Banwell, B.L., 2004. Pediatric multiple sclerosis. Current neurology and neuroscience reports, 4(3), pp.245-252.
  3. Pohl, D., Waubant, E., Banwell, B., Chabas, D., Chitnis, T., Weinstock-Guttman, B. and Tenembaum, S., 2007. Treatment of pediatric multiple sclerosis and variants. Neurology, 68(16 suppl 2), pp.S54-S65.
  4. 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.
  5. U.S. Food and Drug Administration. 2020. FDA Expands Approval Of Gilenya To Treat Multiple Sclerosis In Pediatric Patients. [online] Available at: <https://www.fda.gov/news-events/press-announcements/fda-expands-approval-gilenya-treat-multiple-sclerosis-pediatric-patients> [Accessed 25 October 2020].
  6. Chitnis, T., Arnold, D.L., Banwell, B., Brück, W., Ghezzi, A., Giovannoni, G., Greenberg, B., Krupp, L., Rostásy, K., Tardieu, M. and Waubant, E., 2018. Trial of fingolimod versus interferon beta-1a in pediatric multiple sclerosis. New England Journal of Medicine, 379(11), pp.1017-1027.
  7. Willis, M.A. and Cohen, J.A., 2013, February. Fingolimod therapy for multiple sclerosis. In Seminars in Neurology (Vol. 33, No. 01, pp. 037-044). Thieme Medical Publishers.
  8. Krysko, K.M., Graves, J., Rensel, M., Weinstock-Guttman, B., Aaen, G., Benson, L., Chitnis, T., Gorman, M., Goyal, M., Krupp, L. and Lotze, T., 2018. Use of newer disease-modifying therapies in pediatric multiple sclerosis in the US. Neurology, 91(19), pp.e1778-e1787.
  9. Yeh, E.A., 2011. Current therapeutic options in pediatric multiple sclerosis. Current treatment options in neurology, 13(6), p.544.
  10. Pohl, D., Waubant, E., Banwell, B., Chabas, D., Chitnis, T., Weinstock-Guttman, B. and Tenembaum, S., 2007. Treatment of pediatric multiple sclerosis and variants. Neurology, 68(16 suppl 2), pp.S54-S65.
  11. Yeh, E.A., 2011. Current therapeutic options in pediatric multiple sclerosis. Current treatment options in neurology, 13(6), p.544.
  12. Chitnis, T., 2006. Pediatric multiple sclerosis. The neurologist, 12(6), pp.299-310.
  13. Greenberg, S.J. and Elkins, J.S.B., Biogen MA Inc and AbbVie Biotherapeutics Inc, 2018. Methods of treating progressive forms of multiple sclerosis. U.S. Patent Application 15/804,108.
  14. MacAllister, W.S., Boyd, J.R., Holland, N.J., Milazzo, M.C. and Krupp, L.B., 2007. The psychosocial consequences of pediatric multiple sclerosis. Neurology, 68(16 suppl 2), pp.S66-S69.

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