Multiple sclerosis in children

March 16, 2018
1342
Resume

In 2.2–10.0% of cases, multiple sclerosis (MS) debuts before age 18. In addition to genetic factors, the etiopathogenesis of MS in children may be associated with modified immunological response to virus infection, especially Epstein — Barr, decrease in vitamin D levels, menarche, obesity, smoking. A wide range of childhood diseases that can mimic MS significantly complicates diagnostics. The clinical course of pediatric MS, especially in young children, differs from an adult. Atypical features of MS in children include fever, involvement of other organs, progressive course of the disease, noticeable pleocytosis and absence of oligoclonal bands in cerebrospinal fluid, presence of encephalopathy and larger foci on magnetic resonance imaging. In children, presence of oligoclonal bands in cerebrospinal fluid in the first demyelinating event is an important prognostic factor of the development of MS. MS in children almost always presents in the relapsing-remittent form. The inflammatory nature of the process in the onset of the disease in children leads to a good result of treatment and good prognosis.

O.M. Baranenko, I.P. Krynychna, Y.P. Tiahlo,
I.V. Bachuryna, G.V. Maksiuta

Key words: multiple sclerosis in children, magnetic resonance imaging, oligoclonal bands.

Published: 14.03.2018

References:

  • Anderson R.C., Connolly E.S. Jr., Komotar R.J. et al. (2005) Clinicopathological review: tumefactive demyelination in a 12-year-old girl. Neurosurg., 56(5): 1051–1057.
  • Amato M.P., Goretti B., Ghezzi A. et al. (2010) Cognitive and psychosocial features in childhood and juvenile MS: two-year follow-up. Neurology, 75(13): 1134–1140.
  • Azary S., Schreiner T., Graves J. et al. (2018) Contribution of dietary intake to relapse rate in early paediatric multiple sclerosis. J. Neurol. Neurosurg. Psychiatr., 89(1): 28–33.
  • Banwell B., Bar-Or A., Cheung R. at al. (2008) Abnormal T-cell reactivities in childhood inflammatory demyelinating disease and type 1 diabetes. Ann. Neurol., 63(1): 98–111.
  • Benson L.A., Healy B.C., Gorman M.P. et al. (2014) Elevated relapse rates in pediatric compared to adult MS persist for at least 6 years. Mult. Scler. Relat. Disord.,3: 186–193.
  • Bigi S., Banwell B. (2012) Pediatric multiple sclerosis. J. Child. Neurol., 27(11): 1378–1383.
  • Bo L., Vedeler C.A., Nyland H. et al. (2003) Intracortical multiple sclerosis lesions are not associated with increased lymphocyte infiltration. Mult. Scler., 9(4): 323–331.
  • Brandt A.U., Martinez-Lapiscina E.H., Nolan R., Saidha S. (2017) Monitoring the course of MS with optical coherence tomography. Curr. Treat. Opt. Neurol., 19(4): 15.
  • Brenton J.N., Banwell B.L. (2016) Therapeutic Approach to the Management of Pediatric Demyelinating Disease: Multiple Sclerosis and Acute Disseminated Encephalomyelitis. Neurotherapeutics, 13(1): 84.
  • Callen D.J., Shroff M.M., Branson H.M. et al. (2009) Role of MRI in the differentiation of ADEM from MS in children. Neurology, 72(11): 968–973.
  • Cardoso M., Olmo N.R., Fragoso Y.D. (2015) Systematic review of cognitive dysfunction in pediatric and juvenile multiple sclerosis. Pediatr. Neurol., 53(4): 287–292.
  • Chabas D., Castillo-Trivino T., Mowry E.M. et al. (2008) Vanishing MS T2-bright lesions before puberty: a distinct MRI phenotype? Neurology, 71(14): 1090–1093.
  • Chabas D., Ness J., Belman A. et al. (2010) Younger children with MS have a distinct CSF inflammatory profile at disease onset. US Network of Pediatric MS Centers of Excellence. Neurology, 74(5): 399–405.
  • Chitnis T. (2006) Pediatric multiple sclerosis. The Neurologist., 12(6): 299–310.
  • Dalla Costa G. (2017) Cesarean delivery and artificial lactation are associated with an earlier age of disease onset in multiple sclerosis (https://onlinelibrary.ectrims-congress.eu/ectrims/2017/ACTRIMS-ECTRIMS2017/199875/gloria.dalla.costa.cesarean.delivery.and.artificial.lactation.are.associated.html?f=media=1).
  • Dell’Avvento S., Sotgiu M.A., Manca S. et al. (2016) Epidemiology of multiple sclerosis in the pediatric population of Sardinia, Italy. Eur. J. Pediatr., 175(1): 19-29.
  • Ferreira M.L., Machado M.I., Dantas M.J. et al. (2008) Pediatric multiple sclerosis: analysis of clinical and epidemiological aspects according to National MS Society Consensus 2007. Arq. Neuropsiquiatr., 6(3B): 665–670.
  • Filippi M., Preziosa P., Meani A. et al. (2018) Prediction of a multiple sclerosis diagnosis in patients with clinically isolated syndrome using the 2016 MAGNIMS and 2010 McDonald criteria: a retrospective study. Lancet Neurol., 17(2): 133–142.
  • Hahn J.S., Pohl D., Rensel M., Rao S. (2007) Differential diagnosis and evaluation in pediatric multiple sclerosis. Neurology, 68(16 Suppl 2): 13–22.
  • Harding K.E., Liang K., Cossburn M.D. et al. (2013) Long-term outcome of pediatric-onset multiple sclerosis: a population-based study. J. Neurol. Neurosurg. Psychiatry, 84(2): 141–147.
  • Heussinger N., Kontopantelis E., Gburek-Augustat J. et al.; for GRACE-MS (2015) Oligoclonal bands predict multiple sclerosis in children with optic neuritis. Ann. Neurol., 77(6): 1076–1082.
  • Hu Y., Tornes L., Lopez-Alberola R. (2018) Two cases of pediatric multiple sclerosis after human papillomavirus vaccination. Presented at: ACTRIMS Forum 2018; February 1–3, San Diego, CA. Abstract № P088.
  • Hynson J.L., Kornberg A.J., Coleman L.T. et al. (2001) Clinical and neuroradiologic features of acute disseminated encephalomyelitis in children. Neurology, 56(10): 1308–1312.
  • Jancic J., Nikolic B., Ivancevic N. et al. (2016) Multiple sclerosis in pediatrics: current concepts and treatment options. Neurol. Ther., 5(2): 131–143.
  • Krupp L.B., Tardieu M., Amato M.P. et al. (2013) International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: revisions to the 2007 definitions. Mult. Scler., 10: 1261–1267.
  • Langer-Gould A., Zhang J.L., Chung J. et al. (2011) Incidence of acquired CNS demyelinating syndromes in a multiethnic cohort of children. Neurology, 77(12): 1143–1148.
  • Lee C.G., Lee B., Lee J., Lee M. (2015) The natural course of clinically isolated syndrome in pediatric patients. Brain Dev., 37(4): 432–438.
  • Metz I., Weigand S.D., Popescu B.F. et al. (2014) Pathologic heterogeneity persists in early active multiple sclerosis lesions. Ann. Neurol., 75(5): 728–738.
  • Mikaeloff Y., Suissa S., Vallee L. et al.; KIDMUS Study Group (2004) First episode of acute CNS inflammatory demyelination in childhood: prognostic factors for multiple sclerosis and disability. J. Pediatr., 144(2): 246–252.
  • Mikaeloff Y., Caridade G., Tardieu M. et al. (2007) Parental smoking at home and the risk of childhood-onset multiple sclerosis in children. Brain, 130(Pt. 10): 2589–2595.
  • Mikaeloff Y., Caridade G., Suissa S., Tardieu M. (2009) Hepatitis B vaccine and the risk of CNS inflammatory demyelination in childhood. Neurology, 72(10): 873–880.
  • Mowry E.M., Krupp L.B., Milazzo M. et al. (2010) Vitamin D status is associated with relapse rate in pediatric-onset multiple sclerosis. Ann. Neurol., 67(5): 618–624.
  • Pfeifenbring S., Bunyan R.F., Metz I. et al. (2015) Extensive acute axonal damage in pediatric multiple sclerosis lesions. Ann. Neurol., 77(4): 655–667.
  • Pohl D., Rostasy K., Reiber H., Hanefeld F. (2004) CSF characteristics in early-onset multiple sclerosis. Neurology, 63(10): 1966–1967.
  • Pohl D., Krone B., Rostasy K. et al. (2006) High seroprevalence of Epstein — Barr virus in children with multiple sclerosis. Neurology, 67(11): 2063–2065.
  • Polman C.H., Reingold S.C., Banwell B. et al. (2011) Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann. Neurol., 69(2): 292–302.
  • Reinhardt K., Weiss S., Rosenbauer J. et al. (2014) Multiple sclerosis in children and adolescents: incidence and clinical picture — new insights from the nationwide German surveillance (2009–2011). Eur. J. Neurol., 21: 654–659.
  • Renoux C., Vukusic S., Confavreux C. (2008) The natural history of multiple sclerosis with childhood onset. Clin. Neurol. Neurosurg., 110(9): 897–904.
  • Rovira À., Wattjes M.P., Tintoré M. et al. (2015) Evidence-based guidelines: MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis-clinical implementation in the diagnostic process. MAGNIMS study group. Nat. Rev. Neurol., 11(8): 471–482.
  • Scalfari A., Neuhaus A., Daumer M. et al. (2014) Onset of secondary progressive phase and long-term evolution of multiple sclerosis. J. Neurol. Neurosurg. Psychiatry, 85(1): 67–75.
  • Scheller N.M., Svanström H., Pasternak B. et al. (2015) Quadrivalent HPV vaccination and risk of multiple sclerosis and other demyelinating diseases of the central nervous system. JAMA, 313(1): 54–61.
  • Simone I.L., Carrara D., Tortorella C. et al. (2002) Course and prognosis in early-onset MS: comparison with adult-onset forms. Neurology, 59(12): 1922–1928.
  • Taleb S., Nourbakhsh B., Graves J. et al. (2017) Environmental risk factors associated with pediatric MS: the role of remote viral infections and vitamin D revisited. The 2017 AAN Annual Meeting, April 22–28, Boston, Abstract № S44.003.
  • Verhey L.H., Branson H.M., Shroff M.M. et al. (2011) MRI parameters for prediction of multiple sclerosis diagnosis in children with acute CNS demyelination: a prospective national cohort study. Canadian Pediatric Demyelinating Disease Network. Lancet Neurol., 10(12): 1065–1073.
  • Waubant E., Chabas D. (2009) Pediatric multiple sclerosis. Curr. Treat. Options Neurol., 11(3): 203–210.
  • Waubant E., Mowry E.M., Krupp L. et al. (2011) Common viruses associated with lower pediatric multiple sclerosis risk. Neurology, 76(23): 1989–1995.
  • Waldman A., Ghezzi A., Bar-Or A. et al. (2014) Multiple sclerosis in children: an update on clinical diagnosis, therapeutic strategies, and research. Lancet Neurol., 13(9): 936–948.
  • Waldman A., Ness J., Pohl D. et al. (2016) Pediatric multiple sclerosis: Clinical features and outcome. Neurology, 87(9 Suppl. 2): 74–81.
  • Yang H.Q., Zhao W.C., Yang W.M. et al. (2016) Clinical profiles and short-term outcomes of acute disseminated encephalomyelitis in adult Chinese patients. Clin. Neurol., 12(3): 282–288.