MS (Multiple Sclerosis) In Children: Causes, Signs & Treatment
Timely diagnosis and treatment can help improve your child’s quality of life.
Specialty: PediatricsExperience: 10 yearsDr. Aarti Motiani is a child specialist with a decade of experience in patient care. She has special interest in nutrition, immunization, and development of kids. Dr. Motiani treats kids with minimal medicine and believes in parents counselling for every behavior of the child.
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In This Article
Multiple sclerosis or MS is an autoimmune disorder where the immune system attacks the myelin, an insulating sheath around the brain and spinal cord nerves. If MS in children occurs before the age of 16 years, it is called pediatric MS. Pediatric MS cases account for 4 to 5% of total MS cases.
Myelin aids in the movement of electrical impulses through the nerves. Hence any damage to it can slow the impulse movement (1). Most cases of pediatric MS are diagnosed after the age of ten years, the phase marked by vital years of education and active brain maturation (2) (3).
Read on to know about MS in children, including its symptoms, causes, and treatments.
Symptoms Of Multiple Sclerosis In Children And Teens
The symptoms of MS vary from person to person as this condition can affect any part of the central nervous system (brain, spinal cord, and optic nerves).
Up to 99% of children with pediatric MS are known to have a relapsing-remitting MS, meaning the child might experience recurring attacks that cause new or worsening symptoms, followed by periods without new symptoms (3).
Some of the common symptoms of MS in children and teens are:
- Fatigue
- Weakness
- Tingling sensation and numbness
- Double vision and pain while moving the eye
- Tremors
- Seizures
- Slurred speech
- Balancing issues
- Bowel and bladder problems
- Depression and anxiety
- Cognitive and memory problems
- Stiffness of the joints (4)
Symptoms such as depression and anxiety are seen in 27% of children with MS (5), and 30% of children show cognitive impairment (6). These symptoms appear during the flare-ups and may last for a few weeks to years. A total of 15-20% of MS children have symptoms similar to that of acute disseminated encephalomyelitis (ADEM), such as headache, vomiting, and seizures (2).
Causes Of Multiple Sclerosis
The exact cause of MS is not known; however, researchers believe that it could be a combination of genetic and environmental factors. In children who have a genetic susceptibility, environmental factors act as triggers (7).
Genetics
Monozygotic twins have a 25% chance of developing MS, while the risk rate of dizygotic twins developing it is 2-5%. Studies also found that certain human leukocyte antigen (HLA) genes are associated with an increased risk of early onset of MS (2).
Environmental factors
Environmental factors may also trigger the onset and flare-up of the symptoms of MS. Exposure to viral and bacterial pathogens such as Epstein Barr virus (EBV) is linked with MS. The prevalence of MS is higher in the northern latitudes, and studies have shown that children who immigrate to high-risk countries show the new countries’ risk rate rather than their original countries.
Low levels of vitamin D have also been identified as a risk factor for pediatric MS. However, further studies need to be done to understand the exact role of vitamin D. Passive smoking is also shown to increase the risk of MS by two times in children (2) (7).
Diagnosis Of Multiple Sclerosis
As this condition occurs in a series of relapsing-remitting episodes, it could be challenging to diagnose it during the early stages. A clear diagnosis may not be possible at the time of the first flare-up as the relapsing period may not occur yet. Also, the large number of symptoms associated with the disease make diagnosis challenging.
As new attacks and relapses occur, your doctor may be able to diagnose MS. The following tests would help the doctor diagnose the disease in your child (4).
- The doctor would inquire about your family’s health history and ask about your child’s symptoms.
- A neurological exam may be performed to understand the extent of damage in the central nervous system.
- An MRI scan may also be recommended to further understand the damage in the parts of the brain and spinal cord. It would also help you know if your child developed optic neuritis, an inflammation in the optic nerve between the brain and the eye.
- A lumbar puncture to examine the cerebral fluid for the antibodies and proteins associated with MS may also be done.
Treatment For Multiple Sclerosis In Children And Teens
There is no permanent cure for MS, although your doctor may prescribe medications to reduce the symptoms’ severity during the flare-ups (4).
- Steroids, commonly given through the IV route, are recommended for the acute treatment of symptoms of MS in children. However, long-term treatment with steroids may have some side-effects, such as irritability, difficulty in falling asleep, stomach issues, and high blood pressure and high blood sugar levels.
- Intravenous immunoglobulins may help decrease the unwanted immune response that occurs in MS. The common side effects include headache, muscle and joint pains, and low-grade fever and risk of acquiring infections.
- Plasma exchange may be recommended when the neurological symptoms are difficult to treat. In this process, the blood from the body is removed and washed to eliminate the disease-causing substances.
Home Care For MS
Apart from the medications, you could also make certain lifestyle changes to manage MS symptoms.
- Studies have found that with simple changes in diet, you might be able to reduce the rate of relapses and their severity.
A study suggests that a diet rich in high saturated fat increases the risk of relapse in children, while intake of vegetables shows positive results (8).
Another study suggests that children whose iron intake is less are more susceptible to pediatric MS (9).
- Make sure your child eats a healthy diet that includes foods rich in iron and vitamin D.
- Keep track of your child’s weight, and encourage them to exercise regularly and get plenty of sleep.
- Educate your child about the ill effects of smoking, and encourage them to avoid passive smoke.
Prognosis Of MS
MS is rarely fatal; however, as MS is a progressive disease, it can affect your child’s quality of life. Constant follow-ups and medical care are recommended if your child is diagnosed with MS.
MS also significantly impacts your child’s mental health. Children may develop low self-esteem as they may not perform well at school. Due to the episodes of relapses, children may not have a social life or friends at school, which may further make them feel depressed.
Frequently Asked Questions
1. What is the youngest age for MS?
Most children are diagnosed with MS in their early teen years. According to medical journals, the youngest onset for MS is two years. However, onset before ten years is rare. Approximately three to five percent of cases occur before age 16, and only 0.2 to 0.7 cases are present before age ten (10).
2. What is the life expectancy of a child with MS?
Researchers show that the life expectancy of people with MS is less than seven to 14 years of the average life expectancy of the general population. Life expectancy may vary depending on the quality of care provided (11). Childhood onset may reduce life expectancy since the onset of the disease is much earlier than adults. In pediatric MS, the disease can progress to severity nearly ten years earlier than adult-onset MS. However, with adequate care, most MS complications are manageable and preventable (12).
3. Will MS show up in blood work?
There are no specific blood tests to diagnose MS. Doctors may order blood tests to rule out other possible conditions causing similar symptoms such as Sjogren’s syndrome, hereditary diseases, lupus erythematosus, infections, vitamin or mineral deficiencies (13).
4. Will MS show up on MRI?
Magnetic resonance imaging (MRI) is the gold standard diagnostic test of MS. Brain changes in MS are visible on MRI scans. Usually, MS-related brain lesions are seen deep in the white matter near ventricles (brain fluid spaces) (14).
5. How Is MS different in children?
Children and teens are more vulnerable to relapse of disease than adults. Approximately 98% of children experience relapse and remission of MS and can quickly recover from neurological deficits due to MS compared to adults. However, they are most likely to have cognitive impairments affecting academic performances (15).
MS in children is a type of autoimmune disorder that cannot be completely cured or prevented. However, being a progressive disease, timely diagnosis and treatment is important and may help cope with the condition. If you notice any signs of MS in your children, such as fatigue, difficulty in talking, seizures, or memory problems, you need to consult your child’s doctor immediately. Support them through their condition to help them stay strong both physically and mentally by making the necessary changes to their lifestyle.
Key Pointers
- Multiple sclerosis (MS) is a condition that damages nerve fibers of the central nervous system due to an autoimmune reaction.
- Pediatric MS is usually encountered in children and teens below 16 years, and symptoms may include fatigue, vision problems, balancing difficulties, seizures, and cognitive issues.
- Multiple sclerosis cannot be completely cured, but the symptoms may be managed with steroids, intravenous immunoglobulins, or plasma exchange.
- Maintaining a healthy weight and having a diet rich in iron and vitamin D may prevent relapses.
References
2. Soroor Inaloo and Saideh Haghbin; Multiple Sclerosis in Children; Iranian Journal of Child Neurology (2013).
3. Amy Waldman et al.; Multiple sclerosis in children: an update on clinical diagnosis, therapeutic strategies, and research; HHS Author Manuscripts (2015).
4. Pediatric Multiple Sclerosis; Children’s Hospital of Philadelphia
5. Maria Skokou, Evanthia Soubasi, and Philippos Gourzis; Depression in Multiple Sclerosis: A Review of Assessment and Treatment Approaches in Adult and Pediatric Populations; ISRN Neurology (2012).
6. Laura Julian et al.; Cognitive Impairment Occurs in Children and Adolescents With Multiple Sclerosis: Results From a United States Network; HHS Author Manuscripts (2013).
7. Emmanuelle Waubant et al.; Environmental and genetic risk factors for MS: an integrated review; Annals of Clinical and Translational Neurology (2019).
8. Saeedeh Azary et al.; Contribution of dietary intake to relapse rate in early paediatric multiple sclerosis; Journal of Neurology, Neurosurgery, and Psychiatry (2018).
9. Julia Pakpoor et al.; Dietary factors and pediatric multiple sclerosis: A case-control study; Multiple Sclerosis (Houndmills, Basingstoke, England) (2018).
10 Multiple Sclerosis In The Very Young; Cleveland Clinic
11. Antonio Scalfari, et al; Mortality in patients with multiple sclerosis; National Library Of Medicine (2013)
12 . Prognosis in childhood multiple sclerosis; National Library Of Medicine (2007)
13 .How Is MS Diagnosed; National Multiple Sclerosis Society
14. Multiple Sclerosis: Frequently Asked Questions; Cleveland Clinic
15. Pediatric Multiple Sclerosis; Cleveland Clinic
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