Pediatric multiple sclerosis: current concepts and consensus definitions

Abstract

Multiple sclerosis (MS), a chronic inflammatory autoimmune disease of the central nervous system (CNS) commonly diagnosed in adults, is being recognized increasingly in children. An estimated 1.7%-5.6% of all patients with MS have clinical symptoms before reaching the age of 18 years. In comparison with adults, the diagnosis of MS in children can be more difficult, being dismissed or misdiagnosed as other clinical disorders. Although adults and children share basic aspects of the disorder, children have distinctive clinical features, neuroimaging, laboratory, and courses of the disease. The 2010 McDonald criteria have simplified the requirements for establishing the diagnosis of MS and have been proposed to be applicable for the diagnosis of pediatric MS, mainly in children 12 years and older. This paper describes the distinctive features of common pediatric demyelinating disorders, including MS, and summarizes the most recent advances based on the available literature.

Figure 1

(a) Coronal T1 gadolinium enhanced sequence demonstrating left optic neuritis with enhancement and enlargement of the left optic nerve (arrow). (b) and (c) Axial FLAIR demonstrating typical well-circumscribed ovoid lesions in the juxtacortical and periventricular regions consistent with 2010 McDonald criteria for dissemination in space. (d) and (e) Axial FLAIR and gadolinium enhanced sequences with corresponding asymptomatic enhancing and nonenhancing lesions consistent with 2010 McDonald criteria for dissemination in time. (f) Axial T1 sequence with hypointense lesion associated with acute demyelination and axonal injury.