Multiple sclerosis (MS) is an autoimmune disease. The body’s immune system mistakenly attacks a substance that surrounds and protects the nerves in the brain and spinal cord. This substance is called myelin.
Myelin allows signals to move quickly and smoothly through the nerves. When it’s injured and scarred, the signals slow down and miscommunicate, causing the symptoms of MS.
Symptoms of MS depend on which nerves have been affected. Since the myelin damage is spotty and can affect any part of the central nervous system, the symptoms of MS are unpredictable and vary from person to person.
In children, MS is almost always the relapsing-remitting type. This means the disease alternates between relapses in which symptoms flare up and remissions in which there are only mild or no symptoms. Flares can last days to weeks, and remission can last months or years. Eventually, though, the disease can progress to permanent disability.
Most symptoms of MS in children are the same as in adults, including:
- tingling and numbness
- eye problems including vision loss, pain with eye movement, and double vision
- balance problems
- difficulty walking
- spasticity (continuous muscle contraction)
- bowel and bladder control problems
- slurred speech
Usually symptoms like weakness, numbness and tingling, and vision loss only happen on one side of the body at a time.
Mood disorders occur frequently in children with MS. Depression is the most common, occurring in about
- panic disorder
- bipolar depression
- adjustment disorder
- attention span
- speed and coordination performing tasks
- information processing
- executive functions like planning, organizing, and decision-making
Some symptoms are often seen in children but rarely in adults. These symptoms are:
- lethargy or extreme fatigue
The cause of MS in children (and adults) is unknown. It isn’t contagious, and there’s nothing that can be done to prevent it. However, there are several things that seem to increase the risk of getting it:
- Genetics/family history. MS isn’t inherited from parents, but if a child has certain combinations of genes or a parent or sibling with MS, they’re slightly more likely to develop it.
- Exposure to the Epstein-Barr virus. This virus may act as a trigger that sets off MS in children who are susceptible to it. However, many children are exposed to the virus and don’t develop MS.
- Low vitamin D levels. MS is found more often in people in Northern climates where there’s less sunshine than around the equator where there’s a lot of sun. Our bodies need sunlight to make vitamin D, so people in Northern climates tend to have lower vitamin D levels. Researchers think this may mean there’s a link between MS and low vitamin D. In addition, low vitamin D levels increase the risk of a flare.
- Exposure to smoking. Cigarette smoke, both first-hand use and second-hand exposure, has been shown to increase the risk of developing MS.
Diagnosing MS in children can be difficult for several reasons. Other childhood diseases can have similar symptoms and are hard to differentiate.
Because MS is so uncommon in kids and teenagers, doctors may not be looking for it. Also, tests such as an MRI and spinal fluid often don’t show the changes typically seen in adults with MS. Finally, there may not be much evidence of the disease if the evaluation is done during a remission.
There isn’t a specific test for diagnosing MS. Instead, a doctor uses information from the history, exam, and several tests to confirm the diagnosis and rule out other possible causes of the symptoms.
To make a diagnosis, a doctor needs to see evidence of MS in two parts of the central nervous system at two different times. A diagnosis can’t be made after only one episode.
The tests a doctor may use to diagnose MS include:
- History and exam. A doctor will ask detailed questions about the kinds and frequency of the child’s symptoms and perform a thorough neurologic examination.
- MRI. An MRI shows if any parts of the brain and spinal cord are damaged or scarred. This test will show if there’s inflammation in the optic nerve between the eye and the brain, which is called optic neuritis. This is often the first sign of MS in children.
- Spinal tap. For this procedure, a sample of the fluid around the brain and spinal cord is removed and examined for signs of MS.
- Evoked potentials. This test shows how fast the signals move through the nerves. These signals will be slow in children with MS.
Although there’s no cure for MS, there are treatments aimed at improving flares and slowing progression of the disease:
- Steroids can reduce inflammation and lessen the length and severity of flares.
- Plasma exchange, which removes the antibodies attacking the myelin, can be used to treat a flare if steroids don’t work or aren’t tolerated.
- Although medications to slow disease progression have been approved by the U.S. Food and Drug Administration for use in adults, none have been approved for children under 18. However, these medications are still used in children, but at lower dosages.
Specific symptoms can be treated with other medications to improve quality of life.
Physical, occupational, and speech therapy can also be helpful for children with MS.
Having MS as a child can cause emotional and social challenges. Coping with a serious chronic disease may negatively affect a child’s:
- performance in school
- friendships and relationships with others the same age
- social life
- family relationships
- thoughts about the future
It’s important that a child with MS has access to school counselors, therapists, and other people and resources that can help them through these challenges. They should be encouraged to talk about their experiences and problems.
Support from teachers, family, clergy, and other members of the community can also help children successfully manage these issues.
MS is a chronic and progressive disease, but it isn’t fatal and doesn’t usually lower life expectancy. This is true no matter how old you are when it starts.
Most children with MS eventually progress from relapsing-remitting type to irreversible disability. The disease usually progresses more slowly in children and teens, and significant impairment develops about 10 years later than when MS begins in adulthood. However, because the disease starts at a younger age, children usually need permanent assistance about 10 years earlier in life than those with adult-onset MS.
Children tend to have more frequent flares than adults during the first few years after diagnosis. But they also recover from them and go into remission more quickly than people diagnosed as adults.
Pediatric MS can’t be cured or prevented, but by treating the symptoms, addressing emotional and social challenges, and maintaining a healthy lifestyle, a good quality of life is possible.