I would like to preface this by saying that I am not a neuropediatrician and also not an expert on childhood MS. Therefore, I have not written a post on this topic so far, although a lot has happened in the treatment of childhood MS in recent years.
However, there are always questions to the AMSEL about what the data situation looks like and which preparations can be used in children with multiple sclerosis.
I would like to take this as an opportunity to briefly summarize childhood MS and its treatment. This first part deals with the clinical peculiarities of childhood MS. In a second part, it should be about which preparations are currently approved for the treatment of childhood MS – especially since the placebo-controlled phase III study on the effect of teriflunomide (Aubagio) in pediatric patients was just published (Chitnis et al. Safety and efficacy of teriflunomide in paediatric multiple sclerosis (TERIKIDS): a multicentre, double-blind, phase 3, randomised, placebo-controlled trial. Lancet Neurol 2021 Dec;20(12):1001-1011).
However, this article can only provide some superficial information for orientation – specific questions should definitely be discussed with a neuropediatrician.
3-5% receive their MS diagnosis in childhood
Only 3-5% of all MS diseases occur in the age groups of children and adolescents, whereby a distinction must also be made between the age group of over 10-year-olds and under 10-year-olds, as the occurrence of MS in the latter group is a rarity. Childhood MS usually runs in relapses, the relapse rate in children and adolescents is up to 2.3 times higher than in adults. However, children often recover faster and more completely from a clinical relapse than adults, so it takes on average longer for irreversible disabilities to occur.
In the past, this led to the assumption that childhood MS is more benign than adult MS. However, if one takes into account the onset of the disease on average 10 years earlier, the prognosis of MS starting in childhood and adolescence is rather unfavorable compared to a start in adulthood.
In MRI studies it was shown that children have a higher T2 lesion load and more fresh inflammatory activity (measured by the uptake of gadolinium) at the time of diagnosis. In addition, MRI showed smaller brain volumes than age-matched controls at the time of initial manifestation. In line with these findings, cognitive abnormalities are found in 30 – 50% of all children and adolescents with MS, especially in the area of working memory, which can affect education and the achievement of professional goals. MS-induced fatigue and depression can also have a significant impact on the quality of life of children and adolescents.
Obesity as a special influencing factor in girls
The factors influencing the risk of MS do not differ significantly between adults and children. Vitamin D levels, obesity, a previous infection with the Epstein-Barr virus, and (passive) smoking are also to be mentioned in children and adolescents.
Obesity can lead to an increased risk of MS in girls <18 years, this connection could not be demonstrated in boys. An early menarche (start of menstruation) is also associated with a higher MS risk. Since there is a direct connection between menarche and body mass index (BMI), this finding also underlines the importance of childhood obesity as a risk factor for MS. Obesity also reduces the vitamin D level in all age groups – and the importance of vitamin D as a risk factor for MS is also undisputed. Smoking is also an important risk factor, with children and adolescents being particularly at risk from passive smoking.
Parents should therefore pay attention to a healthy diet, the prevention of obesity through sports and exercise, and the avoidance of passive nicotine consumption. These are of course essential components of healthy growing up, but they play a special role in the context of MS.
Which MS therapies can also be used in children and adolescents – this will be discussed in the next post here on MS-Docblog.
