What is Multiple Sclerosis?

Multiple sclerosis (MS) is a type of autoimmune disease. The body’s immune system protects it from foreign objects. With an autoimmune disorder, it doesn’t recognize its own healthy tissue and attacks it. MS affects the brain, spinal cord and optic (eye) nerve. It harms a protective cover, called the myelin sheath, around neurons (nerve cells). This damage prevents the nerves from sending signals to the body to move, sense or function.

MS is not present at birth. It develops as the immune system matures. Less than 1% of people who have MS are diagnosed before age 10. There are about 5,000 children living with pediatric MS in the United States. About 10,000 children worldwide have MS, according to the National MS Society.

The most common type of MS in children is called relapsing-remitting. That means there are times when the condition is quiet, with few or no symptoms. This remission can last months or years. At other times, the MS symptoms flare up. A relapse could last for days or weeks.

Managing flare-ups is important to maintain the best possible health, function and movement. Typically, children who have MS have a good recovery. Sometimes flare-ups may cause lasting damage to nerves. A child may not get back certain movements or functions.

MS Causes

Doctors and scientists don’t know the exact causes of MS. They believe many factors contribute to the disease. What triggers the immune system to develop MS is unique for every person. If close family members have MS or other autoimmune diseases, the risk of getting MS is higher.

MS Symptoms in Children

Symptoms can be different from child to child. They depend on where damage or inflammation of the myelin sheath occurs.

Common symptoms for MS in children include:

• Weakness, tingling and numbness, often on one side of the body at a time
• Problems with balance and coordination
• Eye problems, such as double vision, pain when moving the eyes and vision loss
• Tremors (shaking)
• Muscle stiffness and spasms, which can be painful
• Problems with bowel and bladder control
• Slurred speech

Other symptoms of pediatric MS include:

• Trouble with memory and paying attention
• Difficulty processing information, organizing, planning and decision-making
• Seizures
• Fatigue

Diagnosing MS in Children

A neurologist is a doctor who specializes in conditions that affect the nerves. The doctor will ask about symptoms and do a neurologic exam. The doctor tests vision, hearing, sensation, strength and swallowing. Coordination, balance and reflexes also are tested. Blood tests may help rule out other reasons for symptoms.

To confirm that a child has MS, doctors use imaging tools. These create pictures of the brain, spinal cord and optic nerve. The main tests are:

• Magnetic resonance imaging (MRI). This uses a large magnet and radio waves to locate and make pictures of inflamed areas.
• Spinal tap. The doctor will remove a sample of fluid surrounding the brain and spinal cord. The lab tests for signs of MS and rules out infections or other diseases.
• Blood work. This rules out other infectious and inflammatory diseases that may have similar symptoms.

MS Treatment in Children

Three categories of MS treatment include:

• Treatment of active inflammation. Steroids often are given to reduce inflammation from an active flare-up. During severe relapses, plasma (liquid part of the blood) exchange is used. This treatment removes antibodies (part of the body’s defense system) from the blood that may be attacking the myelin and causing symptoms.
• Prevention of further relapses. Medications called immunotherapies or immunosuppressants are used to prevent future relapses. Options to help prevent relapses include injectables, oral medications and infusion medications.
• Treatment of symptoms related to MS. Medications used to treat symptoms vary depending on the symptoms caused by MS relapses. These medications may be used during active inflammation or may be needed long term. Psychologists and psychiatrists will treat mood and cognitive symptoms. Occupational, speech and physical therapies are used to aid in recovery from symptoms.

All children with MS remain on medication to help prevent further relapses. Doctors will watch closely for new symptoms. Regular physical exams and MRIs help monitor flare-ups.

MS Long-Term Outlook for Children

Quality and length of life for children with MS have improved greatly over the past 15 years. With new immunotherapies, young people with MS can live a normal lifespan and a full life.

Early diagnosis and getting the right medication are both important for calming down the immune system. Both help a child who has MS to have the best possible quality of life. Doctors should continue to check a child regularly for symptom control.

Those who don’t seek treatment early may have lasting damage to their muscles, eyes, brain, bladder and bowel.

A child who has symptoms – especially if they have a family history of MS or autoimmune diseases – should be evaluated by a neurologist. Prompt care can improve movement, problem solving and thinking.