Pediatric Multiple Sclerosis (MS)

Multiple sclerosis (MS) is a condition caused by an immune system that mistakenly attacks the nerves in the brain, brainstem, optic nerves and spinal cord.

With this disease, a person's immune system eats away at the protective covering around nerves. A healthy immune system protects our bodies from sickness and infection. Sometimes, the immune system gets confused and mistakenly sends cells to parts of the body that aren't in danger or causing harm. When this happens, the immune system damages healthy tissue.

Multiple sclerosis is the most common and well-known type of demyelinating disease. Demyelinating diseases happen when immune cells damage the protective covering that surrounds nerve fibers in your spinal cord, brain and optic nerves.

This disease is very rare in children under age 18. Most people are diagnosed with multiple sclerosis around age 30 but about 5% of them have their first symptom before the age of 18.

The signs and symptoms vary, but common symptoms include:

• Weakness
• Numbness
• Vision changes
• Difficulty with balance and walking
• Bowel/bladder dysfunction
• Fatigue
• Pain
• Cognitive changes, including problems with memory and thinking

Multiple sclerosis is diagnosed by a neurologist. You might bring your child to a neurologist if they have symptoms that concern you or an abnormal MRI. A neurologist will make the diagnosis based on:

• Evidence of demyelination (damage to the myelin sheath surrounding axons) that has happened more than once. A MRI, your child’s history and a physical can help with the diagnosis.
• Whether other conditions with similar symptoms are ruled out. These conditions could include neuromyelitis optica or anti-MOG Associated Disorder.

At Children’s Health℠ CONQUER Clinic, your child’s first appointment will be very detailed and may take up to four hours. They will be evaluated by a neurologist, neuropsychologist, physical medicine rehabilitation specialist and ophthalmologic technician. Our goal is to give your child a thorough evaluation and treatment plan at the first appointment. Through the CONQUER Clinic, we’ll coordinate all of your child’s care between the specialists on our team and other specialists at Children’s Health.

Comprehensive treatment of multiple sclerosis requires a plan to prevent new immune attacks, management of symptoms, evaluation of a child’s educational needs and assessments for rehabilitation services. We offer a variety of short-term, long-term and rehabilitation treatments. Some children will need a combination of all three options. Our team will work with you to choose a treatment plan that best addresses your child’s needs.

Short-term Multiple Sclerosis treatment

The goal of short-term treatment is to stop your child’s body from damaging the nerves in their brain, brainstem, optic nerves and spinal cord. This damage is caused by inflammation. At Children’s Health, we’re proud to offer a variety of treatments that reduce inflammation:

• High doses of steroids that are given through pills, an oral liquid or infusion to treat inflammation. Most children have no side effects from steroids, but some may experience mood changes, appetite changes, difficulty sleeping or irritability.
• Plasma exchange (PLEX) is used to remove the proteins that cause inflammation from your child’s blood. A special IV is used to flow your child’s blood through a machine that removes the specific proteins. Each session takes about 90 minutes. A child typically receives five to seven treatments during an inpatient stay at the hospital.
• Intravenous immunoglobulin (IVIG) is sometimes used as an alternative in addition to steroids and PLEX. IVIG pools together antibodies (which are the part of the blood that helps fight infection) from the blood of thousands of donors. The wide variety of antibodies in IVIG can help stop your child's immune system from creating inflammation.

Long-term Multiple Sclerosis treatment

Immunomodulation therapy prevents your child’s immune system from attacking the brain, spinal cord and optic nerves. Immunomodulation won’t cure the disease or eliminate any previous nerve damage that’s already been done. However, it will prevent attacks from happening in the future. These medicines can be given as a liquid, pill, shot or infusion.

Rehabilitation treatment

Depending on your child’s symptoms, your neurologist will give you a referral to see one of the following specialists:

• Physical therapists (PT) can help your child improve their muscle tone and walking gait.
• Occupational therapists (OT) can help your child improve their ability to function independently.
• Psychologists can help your child manage the emotional challenges that might come with multiple sclerosis.
• Speech-language therapists can help your child better express themselves if they have problems communicating. Sign language, visual aids or speech technology aids have proven to be helpful.