What is 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.
There are several different types of multiple sclerosis (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.
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.
There’s not yet a cure for MS. Treatment options for MS focus on controlling the immune system and helping people manage symptoms.
Who’s at risk for multiple sclerosis?
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)
- 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
How we care for multiple sclerosis
At Boston Children’s Hospital, our Pediatric Multiple Sclerosis and Related Disorders Program provides expert care for your whole child. Our program is led by Mark Gorman, MD, one of the few physicians in the country to complete formal fellowship training in both pediatric neurology and multiple sclerosis. Our program brings together a team from multiple specialties to provide expert medical care and comprehensive support for your child and family.
Multiple Sclerosis (MS) | Symptoms & Causes
What are the symptoms of multiple sclerosis?
Each person’s symptoms vary depending on the location of central nervous system inflammation. Common symptoms of MS in children can include:
- blurry vision or other changes in vision
- tingling or other change in sensation
- loss of balance or coordination
- changes in bladder or bowel function
Cognitive and emotional symptoms?
About 50 percent of people with MS have some cognitive symptoms. These can include:
- difficulty with concentration
- trouble learning and remembering information
- poor judgment
- short attention span
If these symptoms affect your child’s school performance, it’s important to work with your child's school and medical team to help address any problems.
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
- feelings of sadness
- loss of interest in activities
If you notice these signs in your child, let your pediatrician or neurologist know right away.
What are the causes of multiple sclerosis?
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 be caused by any one thing in particular. 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. The particular trigger in a patient is not always identified.
Researchers are working to discover which genes are involved and how they interact. They are also looking at a number of potential environmental and hormonal triggers in hopes of one day finding a cure.
Multiple Sclerosis (MS) | Diagnosis & Treatments
How is multiple sclerosis diagnosed?
Diagnosing multiple sclerosis (MS) can be a challenge, since the symptoms are similar to those of many other conditions and can vary so much from person to person.
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 clinician may also perform tests to rule out other conditions. Tests might include:
What medications are used to treat multiple sclerosis?
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.
Are there other treatments for multiple sclerosis?
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.
Expert care for multiple sclerosis
Because multiple sclerosis is traditionally seen as an adult condition, there is still a lot that needs to be learned about how MS affects children. Our team in the Pediatric Multiple Sclerosis and Related Disorders Program is actively engaged in clinical research to learn about the disease in children, develop new treatments, and improve quality of life.
Multiple Sclerosis (MS) | Frequently Asked Questions
What is 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.
Will my child with multiple sclerosis be OK?
Since the symptoms of MS vary so much from person to person, it’s impossible to predict exactly how your child will be affected. It’s likely that he or she will go through periods where symptoms get better (remit) and then get worse (relapse). Long-term medication use and counseling can help your child maintain a high quality of life.
What is the long-term outlook for my child?
It’s hard to predict what the exact outcome will be for any one person with MS. However, it’s important to know that MS doesn’t shorten a person’s lifespan, and most children with MS are able to lead full lives including things like going to college and having families. Starting a treatment plan early is key to slowing down the disease’s progression. Your clinician can help you develop a treatment plan that ensures the best possible outcome for your child.