Multiple Sclerosis (MS)

Multiple sclerosis (MS) is an autoimmune disease, a disorder in which the body’s immune system reacts against itself and attacks its own healthy cells and tissue. In MS, the immune system reacts against the central nervous system (CNS), which includes the brain, spinal cord, and optic nerves.

The main target of the attack is myelin, the protective coating around nerve cells. Myelin is similar to insulation around an electrical wire. It helps nerve cells to send information from one place to another in the CNS. Attacks on myelin create areas of inflammation, also called lesions, throughout the CNS. The lesions can slow or interrupt the flow of information along nerve cells, resulting in the symptoms of MS.

Once considered a strictly “adult” condition, MS is now being diagnosed earlier, and it’s estimated that somewhere between 3 to 10 percent of patients with MS start developing symptoms before they’re 18. This is also known as pediatric-onset MS, or POMS.

Although researchers don’t fully understand what causes certain people to develop MS, certain environmental and genetic factors can increase the risk.

MS is most common in:

• Females (after puberty)
• Caucasians
• Those with a parent or sibling who has MS or other autoimmune conditions
• People who live in temperate climates, such as the United States, Europe, New Zealand, and Australia; this may in part relate to less sun exposure and low vitamin D levels

There are several different types of MS:

• Relapsing-remitting MS (RRMS): Most children with MS are diagnosed with this type. It’s also the most common form of MS. People with RRMS will have attacks (relapses) of symptoms that go away (remit) and come back later. During the time in between attacks, there are no new symptoms or worsening of the disease.
• Primary progressive MS (PPMS): People with this type of MS have chronic symptoms that steadily get worse over time.
• Secondary progressive MS (SPMS): With this type of MS, symptoms steadily get worse. Most people who have RRMS eventually develop SPMS.

Symptoms of MS vary depending on the location of central nervous system inflammation. Common symptoms of MS in children can include:

• Weakness
• Exhaustion
• Blurry vision or other changes in vision
• Numbness
• Tingling or other change in sensation
• Loss of balance or coordination
• Changes in bladder or bowel function
• Dizziness

Children with MS may also have emotional symptoms in reaction to the stress of living with a chronic, unpredictable illness. Every child has a different way of expressing these emotions, but common signs include:

• Sudden increase or decrease in appetite
• Changes in sleeping patterns
• Low energy
• Irritability
• Feelings of sadness
• Loss of interest in activities

If you notice these signs in your child, let your pediatrician or neurologist know right away.

Uthoff’s phenomenon

Many people with MS have a worsening of their symptoms if they become overheated — either through exercise, weather, or a hot shower or bath. Uthoff’s phenomenon occurs when becoming overheated causes symptoms associated with MS. This is generally the return of symptoms they have had before and different than an MS attack (relapse), because there is no active inflammation in the brain, spinal cord, or optic nerves.

In most cases, the symptoms caused by overheating are temporary and go away when the source of the heat is removed.

The exact cause of MS is still a mystery. But we do know that autoimmune diseases are not contagious, and they don’t appear to have a single cause. Instead, there’s a multi-step process at work:

• Heredity: Children inherit certain genes from their parents that make them more susceptible to a particular disease.
• Environmental factors: The disease doesn’t reveal itself until it’s “triggered” by something — such as an infection or exposure to certain toxins or drugs. Many people with MS appear to have evidence of prior infection with the Epstein-Barr virus, for example. However, we don’t always know the specific trigger that’s responsible.

Researchers are working to discover which genes are involved and how they interact. They are also looking at several potential environmental and hormonal triggers in hopes of one day finding a cure.

There is no one specific test to diagnose MS. Instead, it is diagnosed by using a series of exams and tests to help confirm the condition. MRI criteria, called the MacDonald Criteria, can be very helpful in making the diagnosis. The first step is a complete medical and family history and neurologic exam. Your child’s doctor will also perform tests to rule out other conditions. Tests include:

• Magnetic resonance imaging (MRI)
• Blood tests
• Spinal tap (lumbar puncture)

Although there is no cure for MS, medications can help control the symptoms of MS and slow down the progression of the disease. These medications include:

• Steroids: These medications can reduce inflammation in the brain and spinal cord during attacks of MS. This helps shorten the attacks and reduce their severity.
• Disease-modifying medications: These medications help prevent new attacks and reduce their severity. They can also help slow the progression of the disease.

Medication is just one part of your child's treatment program. Some children with MS may also need physical and occupational therapy to increase mobility and muscle strength, and to learn ways to make day-to-day activities easier on their bodies. And because chronic illnesses can be tough to deal with, psychotherapy or counseling can be valuable in helping kids keep a positive outlook. There are many other treatments available to help with symptoms as needed.

At Boston Children’s, our Neuroimmunology Center provides expert care for your whole child. Our program brings together a team from multiple specialties to provide expert medical care and comprehensive support for your child and family.