Treatment and prognosis of pediatric multiple sclerosis
- Timothy E Lotze, MD
Timothy E Lotze, MD
- Associate Professor of Pediatrics and Neurology
- Baylor College of Medicine
- Section Editors
- Marc C Patterson, MD, FRACP
Marc C Patterson, MD, FRACP
- Section Editor — Pediatric Neurology
- Professor of Neurology, Pediatrics, and Medical Genetics
- Chair, Division of Child and Adolescent Neurology
- Mayo Clinic College of Medicine
- Francisco González-Scarano, MD
Francisco González-Scarano, MD
- Section Editor — Multiple Sclerosis; Neurovirology & NeuroAIDS
- John P. Howe, III, MD, Distinguished Chair in Health Policy
- The University of Texas Health Science Center at San Antonio
Multiple sclerosis (MS) is typically considered to be a disease of young adults. However, pediatric MS, defined as onset of MS before the age of 18, is increasingly recognized and accounts for approximately 5 percent of cases . This disorder was previously known as early onset MS (EOMS) and juvenile MS.
Since pediatric MS is rare, clinicians who see a child with recurrent episodes of acute neurologic symptoms and white matter lesions on brain MRI might initially consider a differential diagnosis that includes leukodystrophies, vasculopathies, sarcoidosis, lymphoma, mitochondrial defects, and other metabolic disorders, rather than MS. Given the availability of disease modifying therapies for MS and the impact on future prognosis, it is important to consider the possibility of pediatric MS in all children with white matter disease. (See "Differential diagnosis of acute central nervous system demyelination in children".)
The prognosis and treatments for children with MS are different from those of the more common adult form, and to a large extent are understudied. This topic will review the treatment and prognosis of pediatric MS. Some of the references on therapy refer to adult patients, since data are limited in pediatric MS and it is assumed that the disease response is likely to be similar.
The pathogenesis, clinical features, and diagnosis of pediatric MS are discussed separately. (See "Pathogenesis, clinical features, and diagnosis of pediatric multiple sclerosis".)
Progression of disability due to MS is highly variable, but accumulating data suggest that progression is slow in most adults with MS. (See "Clinical course and classification of multiple sclerosis", section on 'Rate of worsening'.)
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- TREATMENT OF ACUTE ATTACKS
- INTERFERONS AND GLATIRAMER
- Dose and side effects
- Choosing an agent
- MONITORING RESPONSE TO THERAPY
- REFRACTORY DISEASE
- Other agents
- SYMPTOMATIC MANAGEMENT
- Cognitive impairment
- Other problems
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS