Multiple sclerosis: biological differences in children and adults

Susan S Kim MD PhD (Dr. Kim of the Sacramento VA Medical Center has no relevant financial relationships to disclose.)
Mark A Agius MD (Dr. Agius of Barrow Neurological Institute received honorariums from Novartis, Teva, Biogen, Bayer, Sanofi-Aventis (Genzyme), Acorda, Roche, and Serono for speaking engagements and consulting work.)
Anthony T Reder MD, editor. (

Dr. Reder of the University of Chicago served on advisory boards and as a consultant for Bayer, Biogen Idec, Caremark Rx, Genentech, Genzyme, Novartis, Mallinckrodt, Mylan, Serono, and Teva-Marion.

Originally released October 17, 2012; last updated August 14, 2018; expires August 14, 2021


The behavior of the immune system in children with multiple sclerosis appears to parallel that in children with other chronic inflammatory diseases. Children with multiple sclerosis represent a group in whom a strategy of induction of remission and maintenance of remission is likely to prevent long-term disability. The developing nervous system is a particularly susceptible target of the immune system. At the same time, the potential for enhanced neural plasticity in children provides a unique opportunity for functional recovery along with long-term disability prevention.

Key points


• Epidemiological data support the concept of the onset of multiple sclerosis as a parainfectious process.


• Development of chronic inflammation occurs in susceptible individuals on the basis of molecular characteristics of the individual's immune system.


• The central nervous system provides targets that maintain the long-term immune response, some of which are unique to children.


• Age is an independent variable that, at least in part, determines the course of the disease in multiple sclerosis.


• Monitoring effective immune therapy is important in preventing long-term disability.

Historical note and terminology

The prevalence of pediatric multiple sclerosis has been considered to be low. However, the establishment of pediatric multiple sclerosis centers in the United States has led to an appreciation that pediatric multiple sclerosis represents an unmet need that is often under-diagnosed and undertreated.

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