Pediatric multiple sclerosis

Abstract

Multiple sclerosis (MS) in children manifests with a relapsing-remitting MS (RRMS) disease course. Acute relapses consist of new neurologic deficits persisting greater than 24 hours, in the absence of intercurrent illness, and occur with a higher frequency early in the disease as compared to adult-onset RRMS. Most pediatric patients with MS recover well from these early relapses, and cumulative physical disability is rare in the first 10 years of disease. Brainstem attacks, poor recovery from a single attack, and a higher frequency of attacks portend a greater likelihood of future disability. Although prospective pediatric-onset MS cohorts have been established in recent years, there remains very limited prospective data detailing the longer-term clinical outcome of pediatric-onset MS into adulthood. Whether the advent of MS therapies, and the largely off-label access to such therapies in pediatric MS, has improved prognosis is unknown. MS onset during the key formative academic years, concurrent with active cognitive maturation, is an important determinant of long-term outcome, and is discussed in detail in another article in this supplement. Finally, increasing recognition of pediatric MS worldwide, recent launch of phase III trials for new agents in the pediatric MS population, and the clear imperative to more fully appreciate health-related quality of life in pediatric MS through adulthood highlight the need for standardized, validated, and robust outcome measures. Neurology ® 2016;87 (Suppl 2):S74-S81

The pathology of central nervous system inflammatory demyelinating disease accompanying myelin oligodendrocyte glycoprotein autoantibody

“…Heterogeneity in age at onset, disease course (monophasic versus relapsing), therapies utilized, clinical course, pathology and antibody titers in MOGAD patients in this study is consistent with the literature on MOGAD [34], but clear differences remain from MS and AQP4-IgG-seropositive NMOSD that suggest MOGAD is a distinct entity. The wide range in age of onset of MOGAD is similar to what is observed in other defined subsets of CNS inflammatory demyelinating diseases (both MS and aquaporin-4-IgG seropositive NMOSD can impact children or the elderly) [60,73,74]. There are however unequivocal major differences between MOGAD and MS in presenting manifestations (ADEM is common in MOGAD but very rare in MS), clinical course (a progressive course is not reported with MOGAD but the majority of MS patients eventually develop a progressive course) [30], frequency of CSF oligoclonal bands (8% of MOGAD in our study [similar to prior reports] [15,34] versus MS where it occurs in 88%) [14], and there are a number of MRI differences in the spinal cord, brain and optic nerve that have been reported [7,15,33].…”

Current Advances in Pediatric Onset Multiple Sclerosis

“…In children with a progressive course, other diagnoses should be considered. Children have been reported to have a higher relapse rate compared to adult-onset MS, especially within the first few years of diagnosis [31,32]. Studies have reported 2.3-2.8 times higher relapse rate in pediatric MS, and higher rates of relapse early in the disease if without treatment or on lower efficacy treatment [32][33][34].…”

T-cell activation marker sCD27 is associated with clinically definite multiple sclerosis in childhood-acquired demyelinating syndromes

“…It is shown that children with MS tend to have a more inflammatory disease course than adults. 16 , 17 Therefore, we hypothesised that the predictive value of sCD27 levels for a second attack of MS will be equal or even higher in children than in adults. Furthermore, ADS with encephalopathy (ADEM) are known to have extensive intracerebral inflammation on magnetic resonance imaging (MRI) scans and may have severe clinical presentations.…”