Types of Multiple Sclerosis in Children

Doctors at Hassenfeld Children’s Hospital at NYU Langone are experts at identifying the different types of multiple sclerosis, or MS, in children. This chronic disorder of the central nervous system leads to damage in the brain and spinal cord. It is considered to be an autoimmune disorder, meaning the body’s immune system mistakenly attacks healthy tissue.

In MS, the immune system attacks the protective coating of nerves, called the myelin sheath, throughout the central nervous system. Scar tissue called sclerosis—or lesions—forms at the sites of the damaged myelin. This disrupts nerve impulses traveling to and from the brain and spinal cord. The resulting neurological symptoms vary from person to person, depending on the amount of damage to the myelin and the part of the central nervous system that is affected.

Although MS most commonly occurs in adults, it can also affect children and teens. Approximately 2 to 5 percent of people with MS begin to experience symptoms before age 18.

Symptoms and Causes of Multiple Sclerosis in Children

No one knows what causes MS, though experts believe that genetics and environmental factors play a role in its development. Whereas the genetic factors related to MS are very complex, the risk of a child being diagnosed with MS is somewhat increased if the child has several family members who have the disease.

No two people with MS experience exactly the same symptoms. In addition, symptoms can change or fluctuate over time. Some people may have tremors, fatigue, and muscle tightness, also called spasticity. Others may have sudden vision loss or paralysis, which may be temporary or permanent. MS can also cause forgetfulness or difficulty concentrating, as well as problems with bladder and bowel function.

The symptoms of MS in children are similar to those in adults, but younger children are more likely than adults to have difficulty with balance and coordination of movements. Some develop numbness, and others have itching or irregular sensations, such as a “pins and needles” feeling or burning pains in the arms and legs. Most of these symptoms are the direct result of damage to the myelin in the central nervous system, which is why doctors consider them to be the main symptoms of MS.

Secondary symptoms can arise from neurological changes. Bladder dysfunction, for example, may cause an increase in urinary frequency. This can lead to a child needing frequent bathroom breaks. Another frequent symptom is fatigue, which can interfere with daily activities.

The times when a child experiences new, abrupt MS symptoms are referred to as relapses, or flare-ups. These can be followed by a period when the child does not have symptoms, which is called remission.

By tracking the course of the condition over time, doctors can determine which type of MS is affecting your child.

Clinically Isolated Syndrome

The first time a child experiences neurological symptoms that last at least 24 hours and are determined through diagnostic tests to be caused by inflammation and damage to the myelin sheath, this episode, or “attack,” is known as a clinically isolated syndrome. These attacks are the same as those that occur with MS, but a diagnosis of MS is not made until there are at least two attacks.

Some children may experience only one attack and not go on to develop MS. Depending on the results of testing, such as an MRI scan, our doctors can determine if your child is in the early stages of MS and likely to experience another attack. If symptoms recur, the condition is then referred to as relapsing-remitting MS.

Relapsing–Remitting Multiple Sclerosis

Children with relapsing–remitting MS have attacks that alternate with periods of remission. When symptoms appear, it’s described as a relapse. The child is considered to be in remission when symptoms subside, with or without treatment. Most children are diagnosed as having relapsing-remitting MS.

Typically, symptoms develop over the course of days and then spontaneously improve over weeks or months. Relapses can occur at any time, even after years of remission. Children often experience more frequent relapses than adults who have early MS, but they usually enter remission more quickly.

Heat, fever, infection, fatigue, and stress can increase the severity of symptoms. The severity of a child’s symptoms may change from day to day, and even from hour to hour. Each of these variations in symptom severity is not considered to be a relapse. A symptom must last for more than 24 hours to be considered a relapse.

Secondary-Progressive Multiple Sclerosis

As they age into adulthood, children with relapsing-remitting MS may transition into secondary-progressive MS. This is when the disease begins to progress more steadily, without alternating periods of relapse and remission.

Adults usually transition to secondary-progressive MS about 7 to 10 years after diagnosis. However, children with MS transition more slowly, entering this stage about 20 years after diagnosis. With the availability of MS therapies, this transition may be even further forestalled.

Primary-Progressive Multiple Sclerosis

Primary-progressive MS is when the condition’s neurological dysfunctions occur without relapses or remissions. Children are almost never diagnosed with this form of MS.

If a child experiences the onset of progressive neurologic dysfunction without relapse, it might not be MS but another disorder.

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