Multiple Sclerosis in Children and Teens, Different Than Adults
Multiple sclerosis (MS) usually develops in adults, but infrequently the neurodegenerative disease is diagnosed in children and teens. In fact, MS in young people may be more common than previously believed, although the diagnosis may be missed and the disease is somewhat different than in adults.
Of the estimated 400,000 people diagnosed with MS in the United States, approximately 10,000 are believed to be younger than 18 years old. Some experts believe this figure may be low, partly because it can be challenging to diagnose the disease in young people.
One reason why it’s difficult to diagnose MS in children and teens is because they typically demonstrate or present with different signs and symptoms than do adults. For example, young people can experience delirium, lethargy, seizures, stiff neck, fever, headache, and even coma (collectively referred to as acute disseminated encephalomyelitis, or ADEM) before onset of the disease.
ADEM can persist in some children and then be accompanied by symptoms associated with MS normally seen in adults. However, young people also may continue to experience lethargy and seizures, which are not typical symptoms of adults with MS.
In addition, MS may progress more slowly in children and adolescents, although there is a chance young people will develop greater problems with disabilities at an earlier age when MS develops early. The psychological, social, and academic impacts also can be significant for children and teens who have MS.
A recent study looked at the development of MS before puberty and focused on identifying some typical ways young people present with the disease. The study included 47 pre-pubertal (younger than 11 years) and 41 post-pubertal (14-16 years) young people with relapsing-remitting MS who had had the disease for at least four years.
An evaluation of the patients showed that:
- Pre-pubertal children were more likely to experience a severe first attack of the disease with numerous symptoms that included motor and brainstem involvement, cognitive problems, and sphincter dysfunction followed by milder neurological after effects of the attack that was maintained over two years
- Post-pubertal patients were more likely to experience optic neuritis (inflammation of the optic nerve resulting in partial or complete blindness) and sensory symptoms
Diagnosing MS in young people
A new study in the European Journal of Neurology reported on the incidence of MS among children and adolescents age 15 years or younger. The authors included information from all pediatric hospitals, MS centers, and private practices with an MS focus from 2009 to 2011.
The authors used an active prospective surveillance system and the McDonald criteria (highly sensitive and specific criteria for diagnosing MS) for their analysis and discovered that MS in children and teens is more common than previously believed. They determined that use of spinal magnetic resonance imaging (MRI) allowed them to make an early diagnosis in nearly 90 percent of cases.
Male vs female
Among adults with MS, the disease generally first develops during the childbearing years and is more common among females; that is, a female:male ratio of about 2.5 to 1. However, among pre-pubertal young people, this gender difference does not seem to exist.
This observation, according to a recent report in Clinical Immunology, suggests that puberty plays a key role in the development of MS, especially in females. At least one study has noted that earlier age at menstruation increases the risk of MS development in females.
However, as the authors noted, “Whether this association is a surrogate for a disease causative factor or directly involved in MS disease etiology needs to be uncovered.” Other possible risk factors for MS in young people are obesity and vitamin D deficiency, as recently proposed by researchers from Oxford in Neurology.
Much is still not known or understood about the causes, treatment, or prevention of multiple sclerosis. This holds true for adults as well as for children and teens, who seem to have some different factors involved in the onset and course of the disease.
Chitnis T. Role of puberty in multiple sclerosis risk and course. Clinical Immunology 2013 Nov; 149(2): 192-200
Huppke B et al. Clinical presentation of pediatric multiple sclerosis before puberty. European Journal of Neurology 2013 Dec 16
Pakpoor J, Pakpoor J. Childhood obesity and risk of pediatric multiple sclerosis and clinically isolated syndrome. Neurology 2013 Oct 8; 81(15): 1366
Ramagopalan SV et al. Age of puberty and the risk of multiple sclerosis: a population based study. European Journal of Neurology 2009 Mar; 16(3): 342-47
Reinhardt K et al. Multiple sclerosis in children and adolescents: incidence and clinical picture—new insights from the nationwide German surveillance (2009-2011). European Journal of Neurology 2014 Jan 28