More MS news articles for October 2002

Pediatric MS

http://www.nationalmssociety.org/Pediatric_MS.asp

A number of investigators throughout North America are trying to understand more about early onset MS. At the Pediatric MS Center at Stony Brook University, a study evaluating youngsters with MS or suspected MS, using a team approach, is currently enrolling participants. The research team is assessing the effects of MS on neurologic, behavioral, and social functioning. There is also an opportunity to participate in a research project aimed at studying the causes of MS. Interested individuals should contact Maria Milazzo at 631-444-7802.

The following review of childhood MS was adapted from Kalb, R, DiLorenzo, T, LaRocca, N, Caruso, L, et al. The impact of early onset multiple sclerosis on cognitive and psychosocial indices. International Journal of MS Care (serial online). 1:1-6, September 1999, available at http://www.mscare.com.

Magnetic resonance imaging (MRI) technology has made it possible to diagnose multiple sclerosis earlier and more accurately than ever before. Even with earlier diagnosis, however, it is clear that early-onset MS is relatively rare. Onset before 18 years of age has been reported to occur in only 3% to 5% of cases (Duquette et al., 1987; Ghezzi A et al., 1997). The vast majority of people are diagnosed between the ages of 20 and 50 (Baum & Rothschild, 1981).

Most studies of early-onset MS have reported a higher female to male ratio than is typically seen in adults with MS. While the female to male ratio in adults is approximately 2:1, some studies of children with MS have reported ratios that are closer to 3:1. In one study of 125 subjects, the over representation of girls was even greater in certain subgroups (Duquette et al., 1987). Girls were more likely to exhibit initial symptoms that were purely sensory (e.g., numbness and tingling), complete recovery from the initial episode, a non-progressive clinical course, and lower levels of disability. Boys were more likely to demonstrate no recovery from the initial episode and a progressive course. In another study of 149 children with early onset (Ghezzi et al., 1997), boys slightly outnumbered girls before age 12. After age 12, the number of girls steadily increased until the age of 15, when the ratio became 4:1. The ratio for girls to boys between the ages of 12 and 15 was found to be 3:1, significantly greater than the ratio in adults. No evidence was found in this study to confirm prior reports of male sex and older age at onset being unfavorable prognostic indicators.

The studies of early-onset MS have focused primarily on the diagnosis and treatment of the disease. Most of the studies indicate that the symptoms experienced by children with MS do not differ significantly from those experienced by adults. As with adults, the majority of children are diagnosed with a relapsing-remitting course (Ghezzi et al., 1997; Sindern et al., 1992; Hanefeld et al, 1991). The outcome for children diagnosed with MS seems to be as variable as it can be with adults. Some children do quite well, with a significant period of time passing between relapses; others seem to have a more rapidly progressive course (Cole et al., 1995; Cole & Stuart, 1995; Hanefeld et al., 1991; Boutin et al., 1988).

The drugs currently available to treat MS, including the beta-interferons and glatiramer acetate, have not been extensively studied in children and adolescents. All, however, have been in used in children with no obvious negative effects, and essentially the same benefits as seen in adults.

The literature on childhood MS contains numerous reports of small studies or case reports, and only two studies involving samples of more than 100 children (Ghezzi et al., 1997; Duquette et al., 1987). With very few exceptions, these reports are retrospective in nature, relying on reviews of medical charts or the family members' memories of what occurred. Attention was paid in only four studies to the effects of MS on children's cognitive functioning, self-image, school performance, and social adaptation (Cole et al., 1995; Hanefeld et al., 1991; Kalb et al., 1991; Miller et al., 1990. Youngsters with early-onset MS have yet to complete the acquisition of important intellectual and social skills or the crystallization of their personalities; they are still in the process of acquiring new knowledge in every area of their lives. If MS interferes with this learning process, via any combination of physical, social, or psychological changes caused by the disease, these children are likely to have difficulty acquiring the knowledge and skills needed in adult life.

Neuropsychological studies in MS have demonstrated that approximately 50% of adults will experience some degree of intellectual change (Rao et al., 1991). Of the intellectual deficits associated with MS, memory impairments have been the most extensively investigated and are the most frequently reported by patients and significant others (Richardson, 1996). Three areas of function have been implicated in memory impairments in MS: retrieval, slowed processing speed, and acquisition (Heaton et al., 1985; Beatty & Gange, 1977; Jambor, 1969). Retrieval problems occur when information that has been learned cannot be remembered. Slowing of information processing speed means that thinking, reasoning, and problem-solving occur more slowly. Slowed acquisition of new information means that it takes the person longer to learn new material. Since the essence of learning, whether in academic or social settings, is the acquisition and subsequent recall of new information, the importance of assessing the impact of MS on these processes in children cannot be overestimated.

The symptoms of MS can affect every aspect of a child's daily life at home, with peers, in the classroom, and in sports activities. When physical and/or cognitive impairments interfere with a child's ability to participate actively in these activities, there may be important consequences for the development of his or her self-confidence and self-esteem.

Adolescence is a period of great physical and psychological change, when youngsters begin to make significant life decisions. The diagnosis of a chronic, progressive illness, with uncertain course and outcome, vastly complicates this growth process.

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. Parents and other family members, teachers, and physicians and other healthcare providers all need to understand the impact of MS on a child's physical and emotional well-being and cognitive functioning.