Pediatric Multiple Sclerosis Clinical Presentation

Updated: Jan 03, 2022
  • Author: Alice K Rutatangwa, DO, MSc; Chief Editor: Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP, FANA  more...
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Clinical Presentation

Initial multiple sclerosis (MS) symptoms significantly vary. A confounding factor is the difficulty associated with detecting subtle findings, such as sensory changes or mild symptoms, in young children who have limited body awareness.

Encephalopathy is a common presenting symptom of ADEM. Several studies have shown that encephalopathy may also occur with a first episode of MS or neuromyelitis optica (NMO) and is usually reported in younger patients. [30, 31, 32, 33] ADEM occurs most often in younger children. Thus, rather than being disease specific (ie, MS vs ADEM), the presence of encephalopathy may be related to immaturity of the brain or the immune system in younger patients.

Seizures as first event (as part of the encephalopathy or isolated) in the pediatric population were also reported (29%), usually in ADEM cases and less frequently in MS. [34, 32, 33, 35]

The initial clinical course in the vast majority of patients with pediatric MS is relapsing-remitting [21] to the point that a progressive course from onset in a pediatric patient with MS is a red flag. The annualized relapse rate in pediatric-onset MS has been estimated to be between 0.38 and 0.87 for the whole relapsing-remitting period in the few studies with mean disease duration of 10 years or more. [21]

A prospective study of patients with MS at a large MS center showed that patients with an onset before age 18 years had a higher relapse rate during the first few years of their disease than adults seen at the same institution. [36] While most relapsing-remitting patients have been reported to recover completely and quickly after relapses, disability can result from an incomplete recovery from relapses. In rare pediatric cases, patients later develop a more insidious progression of disability with or without superimposed exacerbations, called secondary progressive MS.