Pediatric multiple sclerosis

Susan S Kim MD PhD (

Dr. Kim of the Department of Veterans Affairs, Memphis VA Medical Center has no relevant financial relationships to disclose.

)
Mark A Agius MD (

Dr. Agius of Dignity Health Medical Foundation received honorariums from Novartis, Genentech, EMD Serono, Alexion, and Sanofi Genzyme as a guest speaker.

)
Anthony T Reder MD, editor. (

Dr. Reder of the University of Chicago received honorariums from Bayer, Biogen Idec, Caremark Rx, Genentech, Genzyme, Novartis, Mallinckrodt, Mylan, Serono, and Teva-Marion for service on advisory boards and as a consultant as well as stock options from NKMax America for advisory work.

)
Originally released October 17, 2012; last updated October 11, 2019; expires October 11, 2022

Overview

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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