Multiple sclerosis (MS) is an autoimmune disease in which the body’s immune system attacks the myelin, an insulating layer or sheath surrounding the brain and spinal cord nerves.
When the symptoms of MS appear before the age of sixteen, it is known as pediatric MS. Studies have found that about 4 to 5% of MS cases are seen in children, with most cases diagnosed after the age of ten, the key formative years of education and active brain maturation (2) (3).
This post tells you about the symptoms, causes, and management options for MS in children.
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:
- Tingling sensation and numbness
- Double vision and pain while moving the eye
- 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).
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 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).
- 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.
MS is a condition that can be hard on your child’s physical and mental health. If your child is
diagnosed with MS, make sure you give them the best medical care and modify your lifestyle. Also, make sure you talk to them about their condition.
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).
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