Abstract
Background Pediatric-onset multiple sclerosis (POMS) prevalence and incidence rates are increasing globally. No disease-modifying therapy are approved for MS pediatric population. Hence, we aim to review the literature on POMS to guide treating physicians on the current understanding of diagnosis and management of pediatric MS. Methods The authors performed a literature search and reviewed the current understanding on risk factors and disease parameters in order to discuss the challenges in assessing and implementing diagnosis and therapy in clinical practice. Results The revised International Pediatric MS group diagnostic criteria improved the accuracy of diagnosis. Identification of red flags and mimickers (e.g. acute disseminated encephalomyelitis and neuromyelitis optica) are vital before establishing a definitive diagnosis. Possible etiology and mechanisms including both environmental and genetic risk factors are highlighted. Pediatric MS patients tend to have active inflammatory disease course with a tendency to have brainstem / cerebellar presentations at onset. Due to efficient repair mechanisms at early life, pediatric MS patients tend to have longer time to reach EDSS 6 but reach it at earlier age. Although no therapeutic randomized clinical trials were conducted in pediatric cohorts, open-label multi-center studies reported efficacy and safety results with beta interferons, glatiramer acetate and natalizumab in similar adult cohorts. Several randomized clinical trials assessing the efficacy and safety of oral disease-modifying therapies are ongoing in pediatric MS patients. Conclusion Pediatric MS has been increasingly recognized to have a more inflammatory course with frequent infratentorial presentations at onset, which would have important implications in the future management of pediatric cohorts while awaiting the results of ongoing clinical trials.
Key Questions about Pediatric Multiple Sclerosis (POMS)
The article "Pediatric multiple sclerosis: a review" provides an in-depth analysis of pediatric-onset multiple sclerosis (POMS), highlighting its increasing prevalence and the unique challenges it presents in diagnosis and management. The authors emphasize the necessity for early and accurate diagnosis, the identification of environmental and genetic risk factors, and the importance of initiating disease-modifying therapies (DMTs) promptly to manage the disease effectively.
What is pediatric-onset multiple sclerosis (POMS), and how does it differ from adult-onset MS?
POMS is defined as multiple sclerosis diagnosed before the age of 16 years. It differs from adult-onset MS in several ways:
- Disease Course: POMS patients predominantly present with a relapsing–remitting course (98%), whereas adult patients have an 84% relapsing–remitting course.
- Presentation: Children are less likely to develop primary or secondary progressive MS during childhood.
What are the challenges in diagnosing POMS?
Diagnosing POMS can be challenging due to:
- Symptom Overlap: Symptoms may mimic other conditions, leading to misdiagnosis.
- Lack of Pediatric-Specific Criteria: While the revised International Pediatric MS group diagnostic criteria have improved diagnostic accuracy, they are not universally applied.
What are the potential environmental and genetic risk factors for POMS?
The article highlights both environmental and genetic factors that may contribute to the development of POMS, though specific details are not provided in the available summary.
What is the current approach to treatment in POMS?
The treatment approach includes:
- Early Initiation of DMTs: Starting disease-modifying therapies early in the disease course is recommended.
- Use of Adult DMTs: Adult DMTs are applied in pediatric MS, though large pediatric cohort data are lacking, and no large placebo-controlled studies have been published yet.
- Ongoing Research: Several randomized clinical trials assessing the efficacy and safety of oral DMTs are ongoing in pediatric MS patients.
By addressing these questions, the article underscores the importance of early and accurate diagnosis, understanding the unique disease course in children, and the need for prompt initiation of appropriate therapies to manage POMS effectively.
