• Multiple Sclerosis—Child

    (MS—Child)

    Definition

    MS is a chronic, disabling disease of the central nervous system. It causes injury to the sheath (called myelin) that covers nerve fibers in the brain, spinal cord, and optic nerves.
    MS is usually diagnosed in adults between the ages of 20-50. The condition also affects children in an estimated 2%-5% of cases.
    Nerve Fiber (Neuron)
    Myelin Sheath Damage
    Copyright © Nucleus Medical Media, Inc.

    Causes

    Malfunction of the body's immune system seems to be the cause of MS. The immune system attacks and damages the myelin. The exact cause of this malfunction is unknown.

    Risk Factors

    Risk factors for MS include:
    • Sex: female
    • Being exposed to certain viruses (herpes virus-6 and Epstein-Barr virus)
    • Having family members who have MS
    • Being of Northern European descent
    • Growing up in a colder climate, as opposed to a tropical climate
    • Having certain immune system genes
    • Having inflammation of the optic nerve
    • Having low vitamin D levels
    • Being obese as an adolescent appears to increase the risk of developing MS

    Symptoms

    There are many different types of MS. When it occurs during childhood, the condition usually takes the form of relapsing and remitting. This means that the symptoms suddenly reappear every few months or years, last for a few weeks or months, then go back into remission.
    The symptoms can range from mild to severe and may include:
    • Numbness or tingling in the face or limbs
    • Impaired vision in one or both eyes (including blurred vision, double vision, loss of vision)
    • Eye pain
    • Fatigue
    • Dizziness
    • Muscle stiffness, spasms, weakness
    • Poor coordination
    • Trouble walking or maintaining balance
    • Weakness in one or more limbs
    • Bladder problems (including urgency, hesitancy, incomplete emptying, incontinence)
    • Bowel problems (including constipation )
    • Slurred speech
    • Difficulty swallowing
    • Forgetfulness, memory loss, confusion, difficulty concentrating or solving problems
    • Seizures
    Factors that may trigger or worsen symptoms include:
    • Heat (including hot weather, hot baths or showers, fever)
    • Overexertion
    • Infection
    These symptoms may be caused by other conditions. If your child has any of these, talk to the doctor.

    Diagnosis

    The doctor will ask about your child’s symptoms and medical history. A physical exam will be done. Tests may include:
    • MRI scan —a test that uses magnetic waves to make pictures of structures inside the brain and spinal cord
    • Sensory evoked potentials—a test that records the electrical responses evoked after a sensory stimulus
    • Lumbar puncture (spinal tap)—removal of a small amount of fluid (CSF) from around the spinal cord to check for white blood cells, antibodies, and proteins
    • Blood tests to rule out other diseases that may mimic MS (eg, B12 deficiency, Lyme disease )
    • Urine tests
    • Visual evoked potential test —to look for problems in the brain that affect vision

    Treatment

    The goals of MS treatment are to:
    • Relieve symptoms
    • Prevent relapses
    • Delay disability
    • Slow disease progression
    Work with the doctor to develop a treatment plan for your child. Options include:

    Medications

    Examples of medicines used to treat MS in children include:
    • Corticosteroids—to reduce inflammation and shorten MS flare-ups
    • Interferon beta —used to suppress the immune system
    • Glatiramer acetate —to help prevent MS relapses by modifying the function of the immune system
    • Intravenous immunoglobulin (a type of antibody)

    Plasma Exchange

    With plasma exchange , the proteins causing the damage to the myelin are removed from the blood. During the plasma exchange, fresh plasma is added back to the blood.

    Other Treatments

    Depending on the symptoms, the doctor may recommend that your child works with a:
    • Physical therapist to help with muscle strength and tone, dexterity, and walking ability—Participating in a regular exercise program may also be helpful.
    • Speech/language pathologist
    • Occupational therapist to help with daily living tasks
    • Psychologist or therapist to help with coping skills
    Your child may also need support from the teachers and staff at her school.

    Alternative Treatments

    Some people with MS have found alternative treatments, such as massage , acupuncture , and magnet therapy helpful. If you are interested in these types of treatments for your child, talk to the doctor.

    Prevention

    There are no guidelines for preventing MS. There may be some steps that you can take to prevent your child from having flare-ups, for example:
    • Give your child her medicines as prescribed.
    • Have your child avoid hot weather and hot baths and showers.
    • Be sure that she gets adequate rest.
    • Encourage your child to exercise regularly.
    • Have her learn stress reduction techniques.
    • Try to have your child avoid infection. You can do this by:

    RESOURCES

    Multiple Sclerosis Association of America http://www.msassociation.org/

    National Multiple Sclerosis Society http://www.nationalmssociety.org/

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html/

    Multiple Sclerosis Society of Canada http://www.mssociety.ca/

    References

    Alan R. Multiple sclerosis. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated March 19, 2010. Accessed July 9, 2010.

    American Association of Neurological Surgeons. Multiple sclerosis. American Association of Neurological Surgeons website. Available at: http://www.aans.org/Patient%20Information/Conditions%20and%20Treatments/Multiple%20Sclerosis.aspx . Updated November 2005. Accessed July 9, 2010.

    Children’s Hospital Boston. Multiple sclerosis. Children’s Hospital Boston website. Available at: http://www.childrenshospital.org/az/Site775/mainpageS775P0.html . Accessed July 9, 2010.

    De la Rocha K. Plasmapheresis. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated November 9, 2009. Accessed July 9, 2010.

    DynaMed Editorial Team. Multiple sclerosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated May 27 , 2010. Accessed July 9, 2010.

    Munger KL, et al. Body size and risk of MS in two cohorts of US women. Neurology. 2009;73(19):1543-1550.

    National Multiple Sclerosis Society. Pediatric (child) MS. National Multiple Sclerosis Society website. Available at: http://www.nationalmssociety.org/about-multiple-sclerosis/pediatric-ms/index.aspx . Accessed July 9, 2010.

    National Multiple Sclerosis Society. Treatments. National Multiple Sclerosis Society website. Available at: http://www.nationalmssociety.org/about-multiple-sclerosis/what-we-know-about-ms/treatments/index.aspx . Accessed July 9, 2010.

    University of California San Francisco Benioff Children’s Hospital. Multiple sclerosis. UCSF Benioff Children’s Hospital website. Available at: http://www.ucsfbenioffchildrens.org/conditions/multiple%5Fsclerosis/index.html . Updated June 17, 2010. Accessed July 9, 2010.

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