Journal of Multiple Sclerosis
ISSN - 2376-0389NLM - 101654564
Review Article - (2021) Volume 8, Issue 2
Background: Multiple sclerosis (MS) is the most important immune-mediated demyelinated disease of human which is typically the disease of young adults. A total of 4% to 5% of MS population are pediatric. Pediatric MS is defined as the appearance of MS before the age of sixteen. About 80% of the pediatric cases and nearly all adolescent onset patients present with attacks typical to adult MS. Approximately 97% to 99% of the affected children have relapsingremitting MS, while 85% to 95% of the adults experience such condition. MS in children is associated with more frequent and severe relapses. Treatment is the same as adults. We aimed to review the epidemiology, etiology, clinical manifestations, and treatment of MS in children.
The diagnosis of multiple sclerosis in both children and adults rests on evidence of inflammatory disease activity in several CNS regions and dissemination in time. Although previous diagnostic criteria have included multiple sclerosis onset after the age of 10 years,42 the present 2010 McDonald criteria formally address the diagnosis of multiple sclerosis in children and provide specific commentary on the application of MRI in paediatric multiple sclerosis. The ability to confirm a diagnosis of multiple sclerosis at the time of an incident attack is unique to the 2010 McDonald criteria, provided that the clinical features are typical of a multiple sclerosis attack and that the MRI shows two T2 lesions in two of four locations commonly affected in patients with multiple sclerosis (periventricular, juxtacortical, brainstem, or spinal cord), with at least one clinically silent enhancing lesion and a non-enhancing lesion.43 The panel summarises the criteria for multiple sclerosis diagnosis in children.
MRI parameters can also be used to predict the risk of MS in children with CIS. In a national prospective inception cohort study at 23 sites in Canada, 284 eligible participants (age < 16 years) were followed up for 3.9 years [1]. Fifty-seven (20%) were diagnosed with MS after a median of 188 days. The presence of either one or more T1-weighted hypointense lesions (HR 20.6) or one or more periventricular lesions (3.34) was associated with an increased likelihood of MS diagnosis. This risk was particularly elevated when both parameters were present (HR 34.27).
A meta-analysis of 14 studies that included children presented with optic neuritis, revealed that older children and those with brain MRI abnormalities at presentation are at greater risk for MS [2]. Data of 223 patients (age range: 2 - 17.8 years) were analyzed. For every 1-year increase in age, the odds of developing MS increased by 32% (odds ratio (OR) = 1.3, p = 0.005). The risk of MS was greater in children with abnormal brain MRI scans at presentation compared with normal MRIs (OR = 28.0, p < 0.001).
Citation: Eoin Baker. Multiple sclerosis in Children: A Systematic Review. J Mult Scler (Foster City), 2021, 8(2), 01.
Received: 04-Feb-2021 Published: 18-Feb-2021, DOI: 10.35248/2376-0389.21.8.237
Copyright: © 2020 Baker E. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
