December 1, 2003
Real Living with Multiple Sclerosis
MULTIPLE SCLEROSIS has always been considered a disease that afflicts adults, usually sometime between young adulthood and middle-age. Only 2% of adult cases, in fact, occur between the ages of 18 and 21. But further MS research may be needed in those cases that do occur in children and adolescents to evaluate whether drug therapy is effective in this younger population.
While treatment is important for all individuals with MS, the shockingly young age that some individuals begin to experience symptoms makes living well with the disease seem even more important. Adolescence can be a difficult time for anyone, without adjusting to life with a chronic disease. In addition to the physical symptoms of MS, the psychological issues that come with the disease can be particularly difficult for children. And, in most cases, children with MS are in for the long haul. As pointed out on the National Multiple Sclerosis Society (NMSS) Web site, "Because MS does not significantly shorten a person's life expectancy, children with MS and their families will be living with the consequences of the illness for decades."
An Uncommon Diagnosis
While the average age of onset of MS in adults is between 20 and 50 years, cases have been seen in children as young as 4 years old. Still, few pediatric cases were reported prior to the 1980s. It's believed that there are many undiagnosed cases of pediatric MS in the United States, and those that are diagnosed are often done so after long delays (magnetic resonance imaging, however, appears to be an effective diagnostic tool, like in adults). Because it's an uncommon diagnosis in children, many other neurologic syndromes are considered before MS in this population. Meningoencephalitis, for example, is a common misdiagnosis.
Generally, the symptoms seen in pediatric cases are the same as those seen in adults. Also, as in adults, the relapsing-remitting disease course is the most common in children.
"The outcome for children with MS seems to be as variable as it can be with adults," according to the NMSS. "Some children do quite well, with a significant period of time passing between relapses; others seem to have a more rapidly progressive course."
One of the most disconcerting aspects of pediatric MS is the effect it can have on memory and learning. Because memory retrieval (the inability to remember things that are learned), slowed processing (delays that occur in thinking), and memory acquisition (difficulties in learning new things) can all be affected, parents and teachers should be particularly aware of the learning difficulties that can occur in children with MS.
Potential Viral Link
Although the causes of MS are not definitively known, infection through a common virus, such as Epstein-Barr virus (EBV), has been postulated as an agent responsible for the disease. Interestingly, new research in pediatric MS patients may actually help determine if this hypothesis is true in all MS patients.
Although such a link has been proposed in adults, making a definitive case for a role in MS for EBV is difficult, as almost all adults eventually test positive for this common virus. Led by Brenda L. Banwell, a neurologist in the Department of Pediatrics, Hospital for Sick Children in Toronto, investigators sought to see if an EBV link to MS could be found as far back as childhood.
To that end, blood serum samples were taken from 25 children diagnosed with MS and 75 of their healthy contemporaries. A significantly higher percentage of children with MS tested positive for EBV, compared with healthy control subjects (89% vs. 31%, respectively). The researchers concluded that EBV is found in nearly all cases of pediatric MS, while other viral connections tested between the two groups did not show any major differences.
Little research has
been conducted in children and adolescents in terms of treatment with the
currently available disease-modifying MS drugs. What research has been
conducted, however, suggests that these drugs have the same beneficial
effects in children as in adults. Moreover, no major negative effects have
been seen in association with MS pharmacotherapy in children and adolescents.
Thus, it's important for pediatricians to be aware of the signs and symptoms
of MS, so potential treatment candidates can be identified.
Copyright © 2003, Real Living with Multiple Sclerosis