Current Series: Early Identification and Management of Multiple Sclerosis in Pediatric Patients

Lauren B. Krupp, MD: The diagnosis of pediatric MS [multiple sclerosis] can be challenging, particularly since most pediatricians will only rarely encounter a kid with this. The frequency is maybe 1 per 100,000, more or less, so it’s not a common thing. The other challenge is that sometimes little kids have symptoms and they don’t tell anybody about them. As an example, a typical presentation is optic neuritis, which is inflammation of the optic nerve. The symptoms associated with that are vision loss or diminishment of vision. We’ve run into situations where a child will have that occur but not say anything until it happens to the other eye. Then they can’t see at all, and you go back and get the history. So a change in vision, such as loss of vision, is 1 very common presentation. Another symptom that can happen is problems with weakness and balance. Just the other day, I saw a youngster who saw their pediatrician with such complaints. They were dragging their leg and it was thought, “Oh, they must have just slept on their leg funny that night or something.” So it can be minimized because, so often, kids get better on their own with so many things.

Another common symptom can be sensory changes like numbness or tingling. That’s a little bit more common among the older kids. The youngest child who I’ve ever seen with MS had their first symptoms at 20 months. The second event was at 27 months. That’s extremely rare. Much more frequent are teenagers, and so MS occurs among those who are 13 and up. Over the age of 17, it’s no longer considered pediatric. But the teenagers, as a group, are the bulk of the kids who have pediatric MS. Those under age 12 are a smaller percentage.

The thing about MS that’s really important to recognize is that this is a relapsing/remitting condition. Whereas adults can sometimes begin with a progressive course, that’s so rare in pediatrics that if you’re dealing with a progressive cognitive problem or a progressive walking problem, you’re not dealing with MS. MS occurs with dysfunction lasting several days, maybe even some weeks, but then there’s improvement until the next attack occurs. The reason I bring this up is that so often symptoms of cognitive challenges occur in kids with learning disabilities, dyslexia, troubles in school. For that to be the only problem, and the presenting problem, and a progressive problem, would be unlikely in MS.

On the other hand, with MS and a diagnosis of MS there can be cognitive changes. The good news is that most of these are relatively mild, but they can interfere. Cognitive slowing is one of the things that can happen. We also know about challenges with multitasking. Sometimes kids will benefit from some accommodations like extra time for tests. In general, one of the bigger challenges with kids, particularly with teenagers, is they want to feel like everybody else. And so, having to have a chronic illness, missing school to make appointments, and sometimes missing exams and classes, can all cause a lot of emotional distress. And when you’ve got some cognitive slowing and you add on to that emotional distress, it can create an even bigger problem. So it’s important that MS be diagnosed promptly, that treatments be provided efficiently, and that psychosocial support be available so that it’s not so challenging for these young kids.