Pediatric multiple sclerosis, or multiple sclerosis starting in children, accounts for betweem 2-10% of all cases. It is characterized by increased diagnostic delay, increased relapse rate and a higher proportion of relapse onset disease, when compared to adult onset disease. In other words, pediatric multiple sclerosis takes more time to be diagnosed in comparison to adult disease; relapes are more frequent and intense; more children start off the disease with relapses than adults. There is less progressive disease in children. Although patients reach disability more slowly, they do so at an earlier age.

Susan Fizgerald. Neurology Today June 06, 2019, vol 19, issue 11

A recent study in Sweden found 549 ( 4,4%) pediatric multiple sclerosis cases among 12482 total cases in the 64 clinics in the country. The median time to reach EDSS 4 was around 30 years in pediatric as compared to 25 years in adult onset patients. The median age at EDSS 4 was respectively 47 and 60 years. The end result in disability was defined early on in the disease. Patients with progressive disease or a high relapse rate at onset reached EDSS 2, 4 and 6 at much earlier ages.

These observations indicate that treatment avaliable in the past 20 years has changed the course of multiple sclerosis, as earlier studies showed 10-20 years to reach the same disability – EDSS 4 – now in the region of 25-30 years. Many experts have indicated that these results are optimistic, because they strongly suggest that on one hand, many patients have a slow disease course. On the other hand, those that have a high early relapse rate or progressive course clearly benefit from early treatment.

MR studies have shown gray matter atrophy in pediatric multiple sclerosis and adult people with MS. These authors found impared gray matter maturation in various cortical and subcortical regions, with atrophy that progressed over an average of 3,5 years, not explained by white matter inflammation. Consequent effects on cognition. They looked at 30 pediatric patients with MS and 26 healthy controls. Atrophy indicates early neurodegeneration in pediatric MS.

and Ermelinda de Meo et al. Neurology 2019, 92:e1729-e1723

Ann Yeh and Eshagi. Neurology 2019, 92:694-695

Gray matter atrophy is closely related to motor deficits in patients with MS of any age. The EDSS and IQs are altered in patients with greater atrophy. In the Italian study there was atrophy in frontal, temporal, parietal, occipital and cingulate regions, and thalamus.

Dr Paulo Bittencourt

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