Medication Summary

Fingolimod is the first drug approved for multiple sclerosis (MS) treatment in children.

Published studies have provided information for off-label use of beta interferons.^{[48, 47, 48]}

Class Summary

These agents may block lymphocyte capacity to egress from lymph nodes, and thereby reduce lymphocyte migration into the CNS.

Fingolimod (Gilenya, Tascenso ODT)

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Fingolimod is the first drug approved for children aged ≥10 years with relapsing forms of MS. The mechanism of action for MS is unknown. It may involve a reduction of lymphocyte migration into the central nervous system. Fingolimod is available as capsules and oral disintegrating tablets.

Class Summary

Immunomodulators or receptor modulators are indicated for the treatment of adults with relapsing forms of MS. They help to slow the accumulation of physical disability and decrease the frequency of clinical exacerbations.

Interferon beta-1b (Betaseron, Extavia)

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Immunomodulators or receptor modulators are indicated for the treatment of adults with relapsing forms of MS. Shown to slow the accumulation of physical disability and decrease the frequency of clinical exacerbations.

Interferon beta 1a (Avonex, Rebif)

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The exact mechanism by which interferon beta-1a exerts its effects is not fully defined. Interferon beta inhibits the expression of proinflammatory cytokines, including interferon gamma, which is believed to be a major factor responsible for triggering the autoimmune reaction leading to MS.

Questions

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Media Gallery

Periventricular increased T2 signal, as shown in this FLAIR image, can be seen in neuromyelitis optica given the dense concentration of aquaporin 4 water channels in this area.
Increased T2 signal at the cervicomedullary junction, as seen in a pediatric patient with MS.
An enhancing lesion in the right superior frontoparietal region. Image 4 shows the same lesion on FLAIR imaging.
FLAIR image of lesion in the right superior frontoparietal region.
This sagittal T2 image of the cervical spine shows small hyperintense lesions typical of MS at C2 C3.
This axial FLAIR image shows bilateral, left predominant confluent signal change. There is also an area of gray matter involvement in the right frontal region. This image would not be sufficient to distinguish an episode of ADEM from pediatric MS in a pre-pubertal child.

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Author

Alice K Rutatangwa, DO, MSc Fellow in Pediatric Multiple Sclerosis/Neuroimmunology, Department of Neurology, University of California, San Francisco, School of Medicine

Alice K Rutatangwa, DO, MSc is a member of the following medical societies: American Academy of Neurology, Child Neurology Society, Pediatric Academic Societies, Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

Emmanuelle L Waubant, MD, PhD Professor of Clinical Neurology and Pediatrics, Director, Regional Pediatric MS Clinic at UCSF, Director, MS Fellowship Program at UCSF, University of California, San Francisco, School of Medicine; Medical Director, Nancy Davis Center Without Walls

Emmanuelle L Waubant, MD, PhD is a member of the following medical societies: American Academy of Neurology, American Neurological Association

Disclosure: Received grant/research funds from Roche for research project; Received grant/research funds from Biogen Idec for fellowship grant; Received honoraria from Teva for speaking and teaching; Received consulting fee from Novartis for board membership; Received honoraria from Genzyme for speaking and teaching; Received honoraria from Questcor for speaking and teaching.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP, FANA Professor of Pediatrics, Neurology, Neurosurgery, and Psychiatry, Medical Director, Tulane Center for Autism and Related Disorders, Tulane University School of Medicine; Pediatric Neurologist and Epileptologist, Ochsner Hospital for Children; Professor of Neurology, Louisiana State University School of Medicine

Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP, FANA is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, American Medical Association, American Neurological Association, Association of Military Surgeons of the US, Child Neurology Society, Southern Pediatric Neurology Society

Disclosure: Nothing to disclose.

Additional Contributors

Teri L Schreiner, MD, MPH Instructor, Fellow in Neuroimmunology, Children's Hospital Colorado, University of Colorado School of Medicine

Teri L Schreiner, MD, MPH is a member of the following medical societies: American Academy of Neurology, Child Neurology Society

Disclosure: Received grant/research funds from National MS Society for employment; Received consulting fee from Questcor Pharmaceuticals for consulting; Received grant/research funds from Teva Pharmaceuticals for other.