Pediatric-Onset Multiple Sclerosis - several studies

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Epidemiology of Pediatric-Onset Multiple Sclerosis: A Systematic Review of the Literature - 2019

Journal of Child Neurology Volume 34, Issue 12 https://doi.org/10.1177/0883073819845827
Anna Jeong, MD anna.jeong at abbvie.com, Denise M. Oleske, PhD, and Joan Holman, MD

Multiple sclerosis onset in youth is increasingly recognized. A systematic review was conducted to assess incidence and prevalence of pediatric-onset multiple sclerosis, focusing on occurrence by age subgroups and disease course. A literature search for the period 1965-2018 was carried out, selecting population-based studies of multiple sclerosis in individuals aged 19 years and younger. Nineteen studies met inclusion criteria. One pediatric neurologist extracted the data. Overall incidence ranged from 0.05 (95% confidence interval 0.03-0.08) to 2.85 (95% confidence interval 2.83-2.86) per 100 000 children and overall prevalence from 0.69 (95% confidence interval 0.58-0.80) to 26.92 (95% confidence interval 26.61-27.23) per 100 000 children. Incidence increased with age. The female-male ratio increased from 1.2:1 in children <12 years old to 2.8:1 in children ≥12 years old. Ten studies (n=521 children) reported disease course. Seven studies found only relapsing-remitting disease and 3 studies found primary-progressive disease in 3.0% to 6.7%. Two secondary-progressive disease cases were identified. Epidemiologic data aid in understanding the magnitude of multiple sclerosis and its clinical phenotypes, for planning for new disease-modifying therapies in the pediatric population.
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Pediatric multiple sclerosis: The 2022 ECTRIMS lecture - May 2023

Multiple Sclerosis Journal Volume 29, Issue 7 https://doi.org/10.1177/13524585231171047 PDF is behind paywall
Brenda Banwell banwellb at chop.eduView all authors and affiliations

The 2022 ECTRIMS lecture focused on pediatric-onset multiple sclerosis (POMS), in recognition of the pivotal importance of prompt recognition and treatment of children and youth diagnosed with multiple sclerosis (MS), enabled over the past decade by the formal inclusion of pediatric patients in the McDonald diagnostic criteria. Epidemiologic, genetic and immunologic research has supported the concept that MS is a single disease across the age span and that clues to the inciting and early facets of MS pathobiology might be uniquely discerned through study of the youngest MS patients. Pediatric trials of pharmaceutical agents approved in adult-onset MS are emerging, although innovative study designs, alignment of regulatory agency requirements for trial design, family-centric models for study visits and emphasis on long-term safety and tolerability are essential. Evidence of safety and efficacy of key therapies is key if POMS patients are to be availed of the full armamentarium of MS therapeutic options. Finally, the rarity of POMS necessitates an international community effort to advance care and research. Such collaborations have been facilitated through the International Pediatric Multiple Sclerosis Group, Multiple Sclerosis International Federation, and by national multiple sclerosis societies. International efforts and priorities for the next decade will be highlighted

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Pediatric Multiple Sclerosis - July 2023

Seminars in Pediatric Neurology Volume 46, July 2023, https://doi.org/10.1016/j.spen.2023.101054 full PDF is behind a paywall
Alexandra B. Kornbluh, Ilana Kahn

The current diagnostic criteria for pediatric onset multiple sclerosis (POMS) are summarized, as well as the evidence for performance of the most recent iteration of McDonald criteria in the pediatric population. Next, the varied roles of MRI in POMS are reviewed, including diagnostic considerations and research-based utilization. The primary role of bloodwork and cerebrospinal fluid studies in the diagnosis of POMS is to rule out disease mimics. Prognostically, POMS portends a more inflammatory course with higher relapse rate and disability reached at younger ages compared with AOMS counterparts. As such, there is an emerging trend toward the earlier use of highly efficacious disease modifying therapies to target prompt immunomodulatory disease control. Current POMS disease modifying therapies (DMTs) and active clinical POMS trials are detailed.

Section snippets
Diagnosis
Pediatric onset multiple sclerosis (POMS), or multiple sclerosis (MS) occurring in patients younger than 18 years of age, occurs in approximately 3%-10% of all cases of MS, and is being increasingly recognized in many world regions.1,2 Just as in adults, the diagnosis of POMS relies on a constellation of characteristic clinical features, neuroimaging, blood tests, and at times spinal fluid analysis, as there is no single finding that can secure the diagnosis. The diagnostic criteria for POMS...

MRI in POMS
The importance of MRI in the evaluation of POMS cannot be underscored. It includes facilitating the diagnosis, ruling out non-MS symptom etiologies, surveilling MS activity to determine the effect of disease modifying therapy (DMT), and in some instances assisting with risk stratification.10 Beyond clinical applications, there are numerous researched-based initiatives that render this modality crucial for our understanding of the disease.10...

Bloodwork
There is no blood test that conclusively helps us make the diagnosis of MS. The primary role of diagnostic bloodwork is to rule out POMS mimics. Laboratory workup at the time of diagnosis is clinician-dependent, as there is no clear consensus on which blood tests are necessary or sufficient. Depending on clinical suspicion for an individual patient, evaluation for mimics such as infections (Lyme disease, HIV), systemic inflammatory disorders affecting the CNS (lupus erythematosus, Sjogren's...

Disease Course and Prognosis
Disability in MS is commonly reported by examining annual relapse rates (ARR), time to level 4 in the Expanded Disability Status Scale (EDSS sustained disability characterized by inability to ambulate without assistance), and time to secondary progression. Using a combination of these measures, numerous large observational retrospective and prospective cohort studies have demonstrated several prognostic characteristics of POMS and distinctions from AOMS....

Acute Treatment
Though mild acute attacks that do not impair function may not require acute immunomodulatory treatment, more bothersome and disabling relapses should be treated with prompt initiation of high dose pulse steroids; methylprednisolone 30 mg/kg/day (maximum 1000 mg) for 3-5 days is preferred. There is moderate evidence to support the use of IVIG and/or plasma exchange in steroid-refractory disease.58...

Disease Modifying Therapies
The last few decades have seen a significant increase in both the number and quality of DMTs...

Future Directions
In sum, there have been marked advancements in the management of POMS in recent years regarding the ability to reach a correct diagnosis earlier, treat promptly with highly efficacious medications, and identify long-term sequelae that require longitudinal support from pediatric neurologists. Nevertheless, future study is needed to continue to optimize patient care and improve quality of life for patients and their families affected by POMS. Diagnostic criteria for the pediatric-specific...

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Preventing Multiple Sclerosis: The Pediatric Perspective - Feb 2022

Front. Neurol., Volume 13 - 2022 | https://doi.org/10.3389/fneur.2022.802380
Duriel Hardy 1,2* Tanuja Chitnis,Tanuja Chitnis 3,4 Emmanuelle Waubant,Emmanuelle Waubant 5,6 Brenda Banwell,Brenda Banwell 7,8

Pediatric-onset multiple sclerosis (MS) is a predominantly relapsing-remitting neuroinflammatory disorder characterized by frequent relapses and high magnetic resonance imaging (MRI) lesion burden early in the disease course. Current treatment for pediatric MS relies on early initiation of disease-modifying therapies designed to prevent relapses and slow progression of disability. When considering the concept of MS prevention, one can conceptualize primary prevention (population- or at-risk population interventions that prevent the earliest facet of MS pathobiology and hence reduce disease incidence), or secondary prevention (prevention of disease consequence, such as reducing relapse frequency and lesion accrual, enhancing focal lesion repair, promoting CNS resilience against the more global facets of disease injury, and ultimately, preventing progression of neurological disability). Studying the pediatric MS population provides a unique opportunity to explore early-life exposures that contribute to the development of MS including perinatal and environmental risk determinants. Research is ongoing related to targeting these risk factors for potential MS primary prevention. Here we review these key risk factors, their proposed role in the pathogenesis of MS, and their potential implications for primary MS prevention.
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>50,000 MSers have been cured by high-dose Vitamin D

Vitamin D fights Multiple Sclerosis, Autoimmune, etc. - Dr. Coimbra video and transcript March 2025

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MS has been increasing attacking both younger and older people for decades

Multiple Sclerosis contains:

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VitaminDWiki - Multiple Sclerosis increasing in teens – at least 2X in 9 years