Multiple Sclerosis in Children and Adults: Does Age Matter?

Pediatric-onset multiple sclerosis in Greece: A single-center study of the risk factors and a review of the literature

Pediatric-onset multiple sclerosis (POMS) accounts for up to 10 % of the affected population. However, it remains an unexplored field in Greece, as no national registry or disease's atlas are currently available. Because of that, we conducted a single-center study. We searched the registries of our hospital during the period January 2010-September 2023 and catalogued 23 children that were under 16 years old when they were first hospitalized in our department and diagnosed with POMS. We compared our data collected to the available literature regarding demographics and the risk factors, and our findings in general meet the acquired POMS knowledge. Most of our children have vitamin D deficiency, previous EBV infection, whilst some of them have personal or family history of autoimmunity. The mean age of first diagnosis is 12.3 years, similar to the global mean age of POMS. Despite the findings obtained, more studies are essential in this field.

Multiple sclerosis under the age of ten: the challenge of a rare diagnosis in a special population - a case series

Introduction

Multiple sclerosis (MS) is a chronic inflammatory demyelinating and degenerative disease of the central nervous system which, when it begins before the age of 18, is defined as paediatric MS. Most common clinical presentations include long tract involvement, brainstem/cerebellum syndromes, optic neuritis and acute disseminated encephalomyelitis. Paediatric-onset MS typically has a more inflammatory-active course and a higher lesion burden in imaging studies, but an extensive post-relapse recovery, with a slower long-term disability progression. The first demyelinating clinical attack occurs before 10 years old in less than 1% of patients, and, in this special population, the condition has particularities in clinical presentation, differential diagnosis, diagnostic assessment, current treatment options and outcome.

Clinical cases

We present the cases of four Caucasian children (2 girls) diagnosed with relapsing-remitting MS before the age of ten, with a mean age at the time of the first relapse of 7.4 ± 2.4 years. Clinical presentation included optic neuritis, myelitis, brainstem syndrome, and acute disseminated encephalomyelitis. Baseline MRI identified several lesions, frequently large and ill-defined. Two patients were included in clinical trials and two patients remain in clinical and imaging surveillance.

Conclusion

Diagnosis of MS before the age of 10 years is rare, but it has significant long-term physical and cognitive consequences, as well as a substantial impact on the current and future quality of life of the child and family. Early and correct diagnosis is essential. Prospective, randomized, large cohort studies are needed to assess the efficacy and safety of disease-modifying treatments in children under the age of ten.