Multiple sclerosis in childhood and adolescence

SummaryMultiple 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.