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Summary
Multiple sclerosis is a chronic inflammatory demyelinating disease of the central
nervous system, typically manifesting in young adults. However, it can be identified
in children in all age groups, including children and adolescents below the age of
eighteen years. It has been reported that at least five percent of patients with multiple
sclerosis experience the clinical onset of disease prior to the age of eighteen. The
majority of children initially present with a relapsing–remitting disease course.
Paediatric multiple sclerosis poses a number of challenges to the physician. In particular,
the initial presenting clinical and radiological features may be difficult to distinguish
from other white matter diseases with a higher prevalence in children than in adults,
notably acute disseminated encephalomyelitis. This can lead to difficulties establishing
an early diagnosis and considering appropriate investigations. Long-term follow-up
of patients with paediatric-onset multiple sclerosis reveals transition to a secondary
progressive course, as well as development of significant neurological deficits, at
a much younger age compared to adult-onset patients. There is growing evidence that
certain disease-modifying therapies are well tolerated and probably of benefit in
paediatric multiple sclerosis. Studies with prolonged follow-up are still needed to
determine the long-term tolerability and benefits of different treatment approaches
in paediatric multiple sclerosis. In view of the potentially devastating long-term
consequences of the disease, treatment should not be delayed. Early initiation of
disease-modifying therapy, as advocated in the adult multiple sclerosis population,
will, it is hoped, translate into improved long-term outcomes in children and adolescents
with multiple sclerosis.
Keywords
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© 2011 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
