Pediatric versus adult MS: similar or different?

Abstract

In this review the most important aspects of pediatric multiple sclerosis are presented and compared with the adult form. Some findings appear peculiar of pediatric MS: a. Clinical manifestations are similar in adolescents and adults with MS, however in very young subjects MS frequency at onset is similar in males and females, with a higher frequency of brainstem/cerebellar involvement and acute polysymptomatic/ADEM like onset; b. The course is relapsing-remitting in the large majority of patients, with a high relapse rate; c. Mild or severe disability is reached after a longer interval, but at a lower age compared to adult MS; d. The frequency of cognitive dysfunction is relatively high, with a quick deterioration but also the capability to partially recover with time; e. MRI is fundamental for diagnosis and prognosis: the pattern of MRI has some peculiar aspects in pediatric MS patients: i) the classic diagnostic criteria cannot be fulfilled, ii) lesion load is more relevant, iii) lesions are less destructive, have a more pronounced inflammatory pattern and have enhanced capability to recover with time; f. Diagnostic criteria of adults can be applied to patients with less than 18 years, but with limitations for subjects with less than 12 years and ADEM-like onset; g. The approach in differential diagnosis is particular complex and many disorders with clinical manifestations in the pediatric age must be considered: in this context it is important to pay attention to clinical, MRI and CSF red flags. Anti-MOG abs syndrome has been recently identified and should be carefully considered in patients with Acquired Demyelinating Syndrome; h. CSF oligoclonal bands are less frequent in pediatric MS patients, their presence in patients with Acquired Demyelinating Syndrome is strongly correlated to the risk of MS; i. The interplay between genetic and environmental factors determine the risk of developing MS; j. MS has a more pronounced inflammatory pattern (as suggested by the high relapse rate and the most relevant inflammatory pattern at brain MRI); k. The treatment is based on the approach used for adults: as MS has a strong impact on patients and their family the model of care should involve a team with specialized neurologists, pediatricians and neuro-pediatricians, nurses, psychologists, social workers and specialists of rehabilitative medicine.

Clinical Features and Risk of Relapse in Children and Adults with Myelin Oligodendrocyte Glycoprotein Antibody–Associated Disease

“…The greater ARR observed across adult subgroups, together with the better CNS capability to recover and repair damage in children, could partially explained the better recovery in children. 26 Interestingly, the lower relapse ratio in children derived from the present study contrasts with the highly active relapsing disease in MS, 27 supporting again the notion that MOGAD and MS are two different entities.…”

The prevalence of MS in the United States

“…Furthermore, diagnosing pediatric MS is challenging; the performance of our proposed algorithm would need to be tested in this population given the recognized differences in relapse rates, more prominent cognitive impairment that may affect health care use, and reported differences in performance of algorithms across the pediatric and adult populations in other chronic diseases. 36–38 This work was out of the scope of the present project but should be pursued in future studies. Second, those with MS not followed in the traditional health care system (e.g., alternative medicine or cash health care practices that bypass health insurance reimbursement) would be missed by our method.…”

Role of B Cells in Multiple Sclerosis and Related Disorders

“…Therefore, it should be treated early and efficiently. 94 A considerable experience with rituximab exists in many immune-mediated disorders of children and adolescents. Rituximab has also been found effective in open-label trials in pediatric patients with MS. 95,96 Clinical data with ocrelizumab and ofatumumab in children/adolescents are still lacking.…”