Pediatric multiple sclerosis is an immune disorder that affects the central nervous system, including the brain, spinal cord and optic nerves. The body attacks a fatty substance called myelin and the nerve fibers that it protects. Pediatric multiple sclerosis is a demyelinating condition, which is any condition that damages myelin.
This damage causes scar tissue (sclerosis) to develop. When myelin and nerves are damaged, the signals that travel between the brain and spinal cord are interrupted or distorted. Demyelination affects the function of many different parts of the body, such as the use and movement of the arms and legs. Changes caused by demyelination result in a wide variety of symptoms that can be mild, moderate or severe and that may get worse over time.
Between 3 and 5 percent of all people with multiple sclerosis (MS) have pediatric multiple sclerosis. Most people with MS are diagnosed between the ages of 20 and 50.
Children diagnosed with multiple sclerosis experience symptoms similar to adults with relapsing-remitting multiple sclerosis, one of four types of MS. This kind of MS is marked by attacks or relapses with new or worsening neurologic symptoms. There are also times of remission when some or all symptoms disappear.
Symptoms of pediatric multiple sclerosis include:
- Numbness or tingling
- Difficulty walking
- Spasticity
- Weakness
- Fatigue
- Vision problems
- Dizziness
- Bladder and bowel problems
- Pain
- Cognitive changes
- Emotional changes
- Depression
The progression of multiple sclerosis in children does differ from the course the condition takes in adults. In pediatric multiple sclerosis:
- Relapses occur two to three times more frequently
- Cognitive impairment appears earlier
- Motor problems take longer to appear
- Significant disabilities appear earlier
Children and teens with multiple sclerosis may also encounter psychosocial issues that affect their performance at school, their relationships with friends and their self-esteem.
Early symptoms of pediatric multiple sclerosis are similar to other conditions, such as acute disseminated encephalomyelitis (ADEM), optic neuritis (inflammation in the bundle of nerves that sends signals from the eye to the brain), transverse myelitis (inflammation in the spinal cord) and recurrent ADEM (acute disseminated encephalomyelitis that returns). This makes it difficult to diagnose pediatric multiple sclerosis. If your child shows signs of the condition, a neurologist will perform specific tests to make an accurate diagnosis.
Multiple sclerosis can affect many different body functions and quality of life. A multidisciplinary team that includes neurologists, physical and occupational therapists, psychologists and social workers will work with you and your child to manage life with pediatric multiple sclerosis.
Diagnosis of Pediatric Multiple Sclerosis
A diagnosis of pediatric multiple sclerosis requires confirmation of demyelination in two different areas of the central nervous system. Doctors at Riley at IU Health perform the following exams and tests to diagnose pediatric multiple sclerosis:
- Medical history. The neurologist will review your child’s medical history and discuss recent symptoms and any changes in cognitive ability.
- Neurological exam. The doctor will check your child’s balance and look for signs of weakness or numbness in the limbs and changes in vision.
- Magnetic resonance imaging (MRI). The doctor will use MRI to look for any damaged areas on the nerves in the brain and spinal cord.
- Lumbar puncture. A sample of spinal fluid is removed and checked for signs of central nervous system infections like meningitis or encephalitis, inflammation, cell count, protein and immune markers.
- Evoked potential tests. This exam measures the brain’s electrical activity in response to the stimulation of specific sensory nerve pathways, such as visual cues, sounds or impulses on the arms or legs. Evoked potential tests can diagnosis demyelination in areas that cause no clinical symptoms or are not easily apparent.
Treatments
Treatments
Treatment for pediatric multiple sclerosis focuses on reducing symptoms, managing relapses and rehabilitation strategies to keep patients mobile and active. Treatments include:
- Medicines. Medicines are used to manage the symptoms of pediatric multiple sclerosis and to reduce and stop the condition's progression. Types of medicines include:
- Disease-modifying therapies. These are self-injectable medicines that are currently approved by the Food and Drug Administration (FDA) for use in adults. These medicines are sometimes used to treat pediatric multiple sclerosis, though they are not approved by the FDA for pediatric use.
- Steroids. In a severe relapse, your child’s doctor may recommend a high-dose corticosteroid given by intravenous injection (IV) for three to five days. This is often followed by oral steroids given on a tapering dose by mouth for a few days. Steroids reduce the inflammation that causes MS attacks.
- Rehabilitation. Physical or occupational therapy can help your child regain or maintain certain muscle movements, improve his or her balance and remain mobile.
- Psychosocial counseling. Living with pediatric multiple sclerosis can cause psychosocial issues such as anxiety and depression. A behavioral therapist can teach your child how to cope with his or her feelings and provide strategies to help him or her feel better. A social worker can address issues at school and at home.
Key Points to Remember
Key Points to Remember
- Pediatric multiple sclerosis is an immune disorder that impairs parts of the central nervous system by damaging the protective myelin (white fatty tissue that surrounds nerves), nerves in the brain and spinal cord and optic nerves.
- Symptoms of pediatric multiple sclerosis include numbness or tingling, difficulty walking and spasticity.
- Children with multiple sclerosis experience relapses or attacks more frequently than adults with the condition.
- Treatments include medicines, physical or occupational therapy and psychosocial counseling.
Support Services & Resources
Support Services & Resources
Visit the links below to find support groups and more resources for pediatric multiple sclerosis.
Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.
The National Multiple Sclerosis Society provides information on pediatric multiple sclerosis, including support groups and the latest research into the condition.
This National Institutes of Health website offers information about the symptoms, treatment and prognosis for patients with multiple sclerosis, as well as links to clinical trials.
Multiple Sclerosis Research
Multiple Sclerosis Research
Pediatric neurologists at Riley at IU Health work closely with researchers, neurologists and neuroscientists at the Stark Neurosciences Research Institute at the Indiana University School of Medicine and the Indiana Clinical and Translational Sciences Institute, where research studies related to multiple sclerosis are underway.
Locations
Locations
Locations
In addition to our primary hospital location at the Academic Health Center in Indianapolis, IN, we have convenient locations to better serve our communities throughout the state.