Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Key Features ++ Pediatric cases account for 5–10% of all cases Exciting discoveries have highlighted the importance of genetic and environmental factors alone and in combination; for example, HLA subtypes Viral exposures Smoking exposure Vitamin D deficiency Diagnostic criteria, including clinical, MRI, and laboratory studies are different among prepubertal patients compared with postpubertal patients +++ Clinical Findings ++ Although there are many similarities between pediatric-onset and adult-onset MS, an earlier age at disease presentation seems to be associated with specific features such as encephalopathy, seizures, and brainstem and cerebellar symptoms A diagnosis of pediatric MS may be made after one episode of demyelination if the MRI scan meets criteria for dissemination in time and space If these criteria are not met, a clinically isolated syndrome is diagnosed; for example, Optic neuritis Transverse myelitis Brainstem, cerebellar, or hemispheric dysfunction Atypical clinical features of pediatric MS include Fever Involvement of the peripheral nervous system or other organ systems Elevated erythrocyte sedimentation rate Marked cerebrospinal fluid pleocytosis Encephalopathy is more commonly associated with acute disseminated encephalomyelitis (ADEM) However, in young children, MS exacerbations may present with encephalopathy, making differentiation of the two disorders difficult Differential diagnosis ADEM Idiopathic transverse myelitis Optic neuritis Rheumatologic disorders like systemic lupus erythematosus, Behçet and Sjögren syndrome and neuromyelitis optica Many other infections, metabolic disorders, and degenerative diseases +++ Diagnosis ++ Initial brain MRI scan of younger patients shows more frequent involvement of the posterior fossa and higher numbers of ovoid, ill-defined T2-bright foci that often partially resolve on the follow-up scan There are several sophisticated MRI criteria to separate pediatric MS diagnosis from alternative diagnoses (eg, ADEM) Spinal fluid in younger patients may fail to reveal oligoclonal bands or elevated IgG index at disease onset +++ Treatment ++ There is no FDA-approved therapy for MS in children Current practice is to use disease-modifying therapies that are approved for adults Retrospective data has shown them to be effective in children Immunomodulatory treatment to prevent relapses in children include Interferon-β 1a or glatiramer acetate (injections) Oral agents fingolimod, teriflunomide, and dimethyl fumarate Natalizumab, rituximab, or cyclophosphamide may be used in refractory cases Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.