Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Treatment and prognosis of pediatric multiple sclerosis

Timothy E Lotze, MD
Section Editors
Marc C Patterson, MD, FRACP
Francisco González-Scarano, MD
Deputy Editor
John F Dashe, MD, PhD


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 [1]. 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'.)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: May 08, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Boiko A, Vorobeychik G, Paty D, et al. Early onset multiple sclerosis: a longitudinal study. Neurology 2002; 59:1006.
  2. Tremlett H, Paty D, Devonshire V. Disability progression in multiple sclerosis is slower than previously reported. Neurology 2006; 66:172.
  3. Confavreux C, Vukusic S. Age at disability milestones in multiple sclerosis. Brain 2006; 129:595.
  4. Renoux C, Vukusic S, Mikaeloff Y, et al. Natural history of multiple sclerosis with childhood onset. N Engl J Med 2007; 356:2603.
  5. Harding KE, Liang K, Cossburn MD, et al. Long-term outcome of paediatric-onset multiple sclerosis: a population-based study. J Neurol Neurosurg Psychiatry 2013; 84:141.
  6. Gorman MP, Healy BC, Polgar-Turcsanyi M, Chitnis T. Increased relapse rate in pediatric-onset compared with adult-onset multiple sclerosis. Arch Neurol 2009; 66:54.
  7. Trojano M, Paolicelli D, Bellacosa A, et al. Atypical forms of multiple sclerosis or different phases of a same disease? Neurol Sci 2004; 25 Suppl 4:S323.
  8. Held U, Heigenhauser L, Shang C, et al. Predictors of relapse rate in MS clinical trials. Neurology 2005; 65:1769.
  9. Waldman AT, Gorman MP, Rensel MR, et al. Management of pediatric central nervous system demyelinating disorders: consensus of United States neurologists. J Child Neurol 2011; 26:675.
  10. Weinshenker BG, O'Brien PC, Petterson TM, et al. A randomized trial of plasma exchange in acute central nervous system inflammatory demyelinating disease. Ann Neurol 1999; 46:878.
  11. Banwell BL. Pediatric multiple sclerosis. Curr Neurol Neurosci Rep 2004; 4:245.
  12. Ghezzi A, Amato MP, Makhani N, et al. Pediatric multiple sclerosis: Conventional first-line treatment and general management. Neurology 2016; 87:S97.
  13. Chitnis T, Ghezzi A, Bajer-Kornek B, et al. Pediatric multiple sclerosis: Escalation and emerging treatments. Neurology 2016; 87:S103.
  14. Ghezzi A, Amato MP, Capobianco M, et al. Disease-modifying drugs in childhood-juvenile multiple sclerosis: results of an Italian co-operative study. Mult Scler 2005; 11:420.
  15. Banwell B, Reder AT, Krupp L, et al. Safety and tolerability of interferon beta-1b in pediatric multiple sclerosis. Neurology 2006; 66:472.
  16. Tenembaum SN, Segura MJ. Interferon beta-1a treatment in childhood and juvenile-onset multiple sclerosis. Neurology 2006; 67:511.
  17. Pohl D, Waubant E, Banwell B, et al. Treatment of pediatric multiple sclerosis and variants. Neurology 2007; 68:S54.
  18. Tenembaum SN, Banwell B, Pohl D, et al. Subcutaneous interferon Beta-1a in pediatric multiple sclerosis: a retrospective study. J Child Neurol 2013; 28:849.
  19. Chitnis T, Tenembaum S, Banwell B, et al. Consensus statement: evaluation of new and existing therapeutics for pediatric multiple sclerosis. Mult Scler 2012; 18:116.
  20. Van Haren K, Waubant E. Therapeutic advances in pediatric multiple sclerosis. J Pediatr 2013; 163:631.
  21. Makhani N, Gorman MP, Branson HM, et al. Cyclophosphamide therapy in pediatric multiple sclerosis. Neurology 2009; 72:2076.
  22. Ghezzi A, Pozzilli C, Grimaldi LM, et al. Safety and efficacy of natalizumab in children with multiple sclerosis. Neurology 2010; 75:912.
  23. Kornek B, Aboul-Enein F, Rostasy K, et al. Natalizumab therapy for highly active pediatric multiple sclerosis. JAMA Neurol 2013; 70:469.
  24. Alroughani R, Ahmed SF, Behbehani R, Al-Hashel J. The Use of Natalizumab in Pediatric Patients With Active Relapsing Multiple Sclerosis: A Prospective Study. Pediatr Neurol 2017; 70:56.
  25. Tysabri prescriber information. www.tysabri.com/en_US/tysb/site/pdfs/TYSABRI-pi.pdf (Accessed on November 28, 2012).
  26. Marriott JJ, Miyasaki JM, Gronseth G, et al. Evidence Report: The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2010; 74:1463.
  27. Makhani N, Schreiner T. Oral Dimethyl Fumarate in Children With Multiple Sclerosis: A Dual-Center Study. Pediatr Neurol 2016; 57:101.
  28. Narula S, Hopkins SE, Banwell B. Treatment of pediatric multiple sclerosis. Curr Treat Options Neurol 2015; 17:336.
  29. Attarian HP, Brown KM, Duntley SP, et al. The relationship of sleep disturbances and fatigue in multiple sclerosis. Arch Neurol 2004; 61:525.
  30. Krupp LB, Alvarez LA, LaRocca NG, Scheinberg LC. Fatigue in multiple sclerosis. Arch Neurol 1988; 45:435.