Pediatric MS: Is it MS?
When a child exhibits MS-like symptoms, it probably means he or she has a problem with myelin. Whether the diagnosis turns out to be MS or not depends on the condition and the lesions. Kids Get MS, Too, by Jayne Ness MD-PhD FAAP, FAAN, tells the story of children 18 and under who have demyelinating conditions. It was published by the University of Alabama Center for Pediatric Onset Demyelinating Disease, one of the six Pediatric MS Centers of Excellence.
Today, I will review this publication and talk about the different conditions that may mimic MS in children. In Ness’ work, there are pictures of MRIs, showing the size and position of the lesions for each type of condition. Although an MRI is useful for identifying one condition over another, there are instances where MS and ADEM are almost identical. Additional tests and criteria may be needed. As useful as an MRI is to confirm MS in adults, MRI criteria may not apply to children under 10. When a young person exhibits MS-type symptoms, it does not necessarily mean MS. Often these symptoms can mean some other demyelinating disease. Pediatric MS Centers of Excellence support families and children while evaluating neurodegenerative conditions. A growing awareness of Pediatric MS results in more accurate diagnoses of neurological diseases affecting young patients. Pediatric MS accounts for two to five percent of the MS population. Adult MS diagnosis and treatments are often used as a guideline for MS in children. Kids Get MS, Too does a good job to remind us that children are more than small adults.
Beginning treatment as soon after MS onset is recommended for adults, but it is unclear if that is beneficial for children. Conditions that cause MS-like symptoms include the following:
- Pediatric-onset MS (Pediatric Multiple Sclerosis) - Diagnosed by 14
- ADEM (Acute Disseminated Encephalomyelitis) - Developed at 5 1/2 years, intense inflammation following virus or vaccination, fever, fatigue, nausea, sometimes encephalitis-like symptoms,
- TM (Transverse Myelitis) - By age 10, inflammation across both sides of one section of the spine, back pain, muscle weakness, abnormal sensations in feet and toes that lead to more serious symptoms such as paralysis. Considered a clinical isolated syndrome.
- ON (Optic Neuritis) - Onset at 12, inflammation and demyelination of optic nerve, presents as blurriness, complete or partial blindness, pain. Considered a clinical isolated syndrome.
- CIS (Clinical Isolated Syndrome) - By 11, one of several first neurological MS incidents lasting at least 24 hours that may eventually lead to MS diagnosis
- Ages = mean ages
Pediatric Onset MS
Pediatric MS is defined as MS in those under the age of 18. It can occur in children under two, but it is more likely to be identified in teens. As with adults, most young MSers have a relapsing/remitting type (RRMS). According to Kids Get MS, Too, children with MS in the Alabama clinic described in the book are likely to be female and African American.
Symptoms that indicate pediatric onset MS are similar to adult symptoms, such as vision problems, numbness, depression, and cognitive problems. One-third of young MSers have cognitive problems that result in poor school performance and get worse as time with the disease continues.
Adult treatments such as interferons or infusions of corticosteroids are used to reduce the number of relapses. Although these medications are not approved by the FDA specifically for children, doses are generally reduced. There have been no tests to determine which drugs and what dosage are best for kids. The National MS Society says the adult disease-modifying drugs are probably safe and tolerated in children.
It may be time to test for ADEM if, after a seizure, a child has unexplained sleepiness, lethargy, or new onset of psychosis. In one example case, an infusion of methylprednisolone was given, and after a short period of time with no further treatments, the patient was back to normal.
Only 10 percent of ADEM patients develop MS. A second recurrence more often leads to MS. If the child is young at onset, MS is unlikely. MS is more likely with adolescent onset.
Clinical Isolated Syndrome
CIS cases may develop into MS up to half of the time. These may be ON, TM, or some other hemispheric dysfunction. For children younger than 10 years old, MS can be definite after only one episode. Children are very difficult to diagnose. Sometimes the child does not complain or report symptoms. Although there is no data to prove it, both the Poser and McDonald Criteria can be applied, but there are times the child is unable to co-operate with the tests. A single event may be enough to diagnose a child if there are multiple lesions on the MRI.
Parents have a big job providing support. They must monitor the disease progress to report changes to the doctor. Parents must actively work with the rest of the family and with the school and teachers to provide an optimum learning environment. With all of this, the kids still need the chance to be kids.
It is unclear if the early treatment makes a difference as it does in adults. There is not enough history to determine if that is true. Young MSers must make their plans for the future with an expensive, unpredictable chronic disease. Depression is very common. Children must learn to manage problems such as spasticity and bladder issues.
Kids Get MS, Too is a publication offering much information and hope. Children seem to have the ability to regenerate myelin. Although many of the diagnosed children will have to learn to live with their disease for the rest of their lives, that may not be true for all of the conditions. For example, Clinical Isolated Syndromes may recur or may never happen again. ADEM lesions often disappear, and the children completely recover. Young people with MS get better as the lesions tend to get smaller with time.
Notes and Links: