Multiple sclerosis (MS) is an autoimmune disease. The body’s immune system mistakenly attacks a substance called myelin that surrounds and protects the nerves in the brain and spinal cord.
Myelin allows signals to move quickly and smoothly through the nerves. When it’s injured, the signals slow down and miscommunicate, causing the symptoms of MS.
MS diagnosed in childhood is called pediatric MS. Few people with MS — somewhere between
Symptoms of MS depend on which nerves have been affected. Because the myelin damage is spotty and can affect any part of the central nervous system (CNS), the symptoms of MS are unpredictable and vary from person to person.
In children, relapsing-remitting MS is almost always the diagnosis. This means the disease alternates between relapses, in which someone develops new symptoms, and remissions, in which there are only mild or no symptoms.
Flares can last days to weeks, and remission can last months or years. Eventually, though, the disease can progress to permanent disability.
Most symptoms of MS in children are the same as in adults, including:
- tingling and numbness
- eye problems, including vision loss, pain with eye movement, and double or blurred vision
- balance problems
- difficulty with coordination or walking
- involuntary muscle spasms (spasticity)
- bowel and bladder control problems
- slurred speech
Symptoms like weakness, numbness and tingling, and vision loss often happen on only one side of the body at a time.
Some children with MS may experience seizures, but only rarely do adults have them.
Mood and cognition
Mood disorders occur frequently in children with MS. Depression is the most common. In a
Other frequent conditions include:
Some of the most frequently affected activities include:
- attention span
- speed and coordination performing tasks
- processing incoming information
- planning, organizing, and decision-making
Much like physical symptoms, cognitive and mood symptoms can often be addressed with treatment and supports.
The cause of MS in children (and adults) is unknown. It is not contagious, and it cannot be prevented. However, there are several things that seem to increase the risk of developing it:
- Genetics/family history. A child does not inherit MS from their parents, but if a child has certain combinations of genes or a parent or sibling with MS, they’re slightly more likely to develop it.
- Exposure to the Epstein-Barr virus. This virus may act as a trigger that activates, or sets off, MS in children who are more likely to develop it. However, many children are exposed to the virus and do not develop MS.
- Low vitamin D levels. MS is found more often in people in northern climates where there’s less sunshine than around the equator. Our bodies need sunlight to make vitamin D, so people in northern climates tend to have lower vitamin D levels. Researchers think this
may mean there’s a linkbetween MS and low vitamin D. In addition, low vitamin D levels increase the risk of a relapse.
- Exposure to smoking. Cigarette smoke, both firsthand use and secondhand exposure, has been shown to increase the risk of developing MS.
Diagnosing MS in children can be difficult for several reasons.
Other childhood diseases can have similar symptoms and are hard to differentiate. Because MS is so uncommon in kids and teenagers, doctors may not be looking for it.
There isn’t a specific test for diagnosing MS. Instead, a doctor uses information from the history, exam, and several tests to confirm the diagnosis and rule out other possible causes of the symptoms.
To make a diagnosis, a doctor needs to see evidence of MS in two parts of the CNS at two different times. A diagnosis can be made after only one episode with abnormalities seen on magnetic resonance imaging (MRI) if there’s evidence of MS in the spinal fluid and all other possible causes of symptoms and MRI findings are ruled out.
The tests a doctor may use to diagnose MS include:
- History and exam. A doctor will ask detailed questions about the kinds and frequency of the child’s symptoms and perform a thorough neurologic examination.
- MRI. An MRI shows whether any parts of the brain and spinal cord are damaged. It can also show if there’s inflammation in the optic nerve between the eye and the brain, which is called optic neuritis.
- Lumbar puncture. This is also known as a spinal tap. For this procedure, a sample of the fluid that surrounds the brain and spinal cord is collected and examined for signs of MS.
- Evoked potentials. This test shows how fast the signals move through the nerves. These signals will be slow in children with MS if there’s a history of optic neuritis.
- Optical coherence tomography. This is a test that takes a picture of the optic nerve and can look for thinning. This can pick up a history of optic neuritis that might not have caused any symptoms.
Although there’s no cure for MS, there are treatments aimed at reducing new lesions and relapses and slowing the progression of the disease:
- Corticosteroids can reduce inflammation and lessen the length and severity of relapses.
- Plasma exchange, which removes the antibodies attacking the myelin, can be used to treat a relapse if steroids do not work or are not tolerated.
- Fingolimod (Gilenya) is a prescription medication approved by the Food and Drug Administration (FDA) to treat relapsing MS in children ages 10 years and older. It is a disease modifying therapy (DMT) that is taken in pill form.
- Several other DMTs approved for adults are currently in clinical trials to find out if they are safe and effective for use in children with MS.
Specific symptoms can be treated with other medications to improve quality of life.
Physical, occupational, and speech therapy can also be helpful for children with MS.
A diagnosis of MS for a child can be life changing. Living well with MS requires careful management and follow-up care. But the activities, interests, and general life of a child with MS shouldn’t have to change just because of their diagnosis.
Adjusting to life with MS might sometimes mean learning to do things differently. For example, an occupational therapist can help with setting up assistive devices or finding strategies to reduce the impact of MS symptoms on schoolwork.
Because pediatric MS is almost always the relapsing-remitting type, a child with MS will likely have symptoms that come and go. Most people diagnosed with MS in childhood will not develop significant, permanent physical disability for at least 20 years after diagnosis.
The experience of pediatric MS for every child will be different. But overall, children with MS should be encouraged to keep on pursuing their friendships, hobbies, and plans for the future.
Relapses can happen without warning, and the causes aren’t always known. But following a treatment plan carefully and living a health-promoting lifestyle may help make relapses less frequent.
Like most other kids and teens, children with MS are likely to benefit from regular physical activity. A
Overweight and obesity appear to be risk factors for pediatric MS. These factors may worsen inflammatory diseases like MS. If this is a concern, speak with the child’s healthcare team.
Smoking and being around cigarette smoke may also cause MS to progress faster. Avoiding smoking is something to discuss with children with MS.
Stress is a potential trigger for relapse. Avoiding stressful situations and helping children learn to manage stress may be helpful.
Illness and infection are also possible causes of relapse. While these conditions can’t always be avoided, preventive healthcare options like the flu shot may reduce the risk.
Children tend to relapse more often than adults with MS, but they also recover more quickly.
The eating plan of someone with MS is important in helping prevent relapses, especially in children. According to the National Multiple Sclerosis Society, a healthy diet can reduce the risk of MS getting worse.
However, there’s no proven “best diet” for people with MS, yet. Researchers are continuing to work on answering this question. For now, experts emphasize that eating a nutrient-rich, balanced diet and avoiding highly processed foods and sugar is the right choice for people with MS, including children.
Links between diet and pediatric MS
Studies on diet and pediatric MS have suggested some links between the two.
The study showed no association either way with an increase in carbohydrates, cholesterol, dairy, fiber, fruit, iron, or sugar.
It’s possible that excess fat intake could trigger increased inflammatory chemicals or affect gut microbiota.
Making healthy choices
Here are some foods and nutrients thought to improve an MS diet for children:
- A balanced diet. A healthy balance of complex carbs, healthy fats, protein, fruits, and plenty of vegetables promotes general health.
- Iron. Foods rich in iron include leafy green vegetables like spinach, beans, chicken, turkey, and fortified whole grain breads and cereal.
- Omega-3 fatty acids. These can be found in foods like salmon, flaxseed, and walnuts as well as supplements. Omega-3 fatty acids
may be linkedto lower relapse rates in adults with MS.
- Vitamin D. Low vitamin D
may be linkedto a higher incidence of MS. Fatty fish like salmon and cod, canned tuna, egg yolks, mushrooms, fortified foods, and vitamin D supplements are good choices.
Here’s what to avoid in a pediatric MS diet:
- saturated fats
- sugar, as it may be linked to more severe symptoms
- highly processed foods and refined grains
- excessive salt
It’s not clear whether gluten intolerance and MS are linked.
If you are considering adding supplements or removing foods from a child’s diet, it’s best to discuss those changes with the child’s healthcare team.
Living with a chronic disease like MS is likely to affect a child’s emotional well-being and social life. This can have an impact on:
- self-image and confidence
- relationships at school (and work, for teens)
- friendships and relationships with others the same age
- family relationships
- thoughts about the future
As a child learns more about their diagnosis, symptoms, and treatment, ongoing education and support from their doctor can help.
It’s important that a child with MS has access to supports, like a school counselor, a therapist, or other people and resources that can help them through challenges that may arise. This could include teachers, family, and clergy. They should be encouraged to talk about their experiences and feelings.
Finding ways to connect with other children with MS and their families may be equally important. This can help prevent isolation, and provide support and understanding. Some MS organizations may provide opportunities to connect with other families locally or online.
MS is a chronic and progressive disease, but it is not fatal and does not usually lower life expectancy. This is true no matter how old you are when it starts.
Most children with MS eventually progress from relapsing-remitting type to irreversible disability. While every person with pediatric MS is different, the transition to secondary progressive MS usually takes about 28 years from diagnosis, happening around 40 years old for most.
Because the disease usually progresses more slowly in children and teens, significant impairment develops about 10 years later than when MS begins in adulthood. However, because the disease starts at a younger age, children usually need permanent assistance about 10 years earlier in life than those with adult-onset MS.
Children tend to have more frequent flares than adults during the first few years after diagnosis. But they also recover from them and go into remission more quickly than people diagnosed as adults.
Pediatric MS cannot be cured or prevented, but by treating the symptoms, addressing emotional and social needs, and maintaining a health-promoting lifestyle, a good quality of life is possible. Most children are able to manage their symptoms well and continue living a full life.
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