Multiple sclerosis (MS)
Multiple sclerosis (MS) is a chronic inflammatory disease that affects the central nervous system, including the brain, spinal cord and optic nerves. It is considered an autoimmune disease, which means it occurs as a result of the body's immune system attacking and damaging its own nervous system.
MS damages the outer covering of nerve cells, called myelin, which is a fatty tissue that protects nerve cells in the same way that insulation protects electrical wiring in a house. Myelin helps nerve fibers conduct electrical impulses to and from the brain. Scar tissue, called sclerosis, accumulates when multiple areas of myelin are damaged. These damaged areas also are known as plaques or lesions.
When MS damages the protective myelin sheath of nerve cells, the sheath sometimes repairs itself and nerves work correctly again. In other cases, the myelin is so damaged that the underlying nerve does not repair itself and dies. Sometimes, the nerve cells are damaged and degenerate independently of myelin sheath injury.
The cause of MS is not yet known. Factors such as inflammation, infections, poisons and drugs may damage the myelin sheath, but none of the factors has been identified as the cause of the disease. Heredity also may contribute to the development of the condition.
About 5 percent of patients have a sister or brother who has MS and about 15 percent have a close relative with the disease, although a specific MS gene abnormality has not yet been identified. Other factors like environmental factors might be involved as the incidence of disease significantly varies with the geographical latitude.
Over time, MS usually evolves into alternating periods of good health, called remission, and disabling flare-ups of the disease, known as relapses. The prognosis for children with MS varies.
At UCSF's Children's Hospital, our Pediatric Multiple Sclerosis Center is dedicated to improving the treatment, diagnosis and awareness of children and adolescents with MS and related diseases. It is the only center of its kind on the West Coast and is designated by the National Multiple Sclerosis Society as a center of excellence in comprehensive care for pediatric patients with MS.
Signs & symptoms
About 400,000 Americans suffer from multiple sclerosis (MS), which is most commonly diagnosed in young adults. In rare cases, the condition affects infants, children and adolescents. Up to 5 percent of people with MS experience symptoms before the age of 18.
Due to a recent increase in education about pediatric MS, the number of children diagnosed has risen. But there is still a lack of awareness about the disease in those under age 18 and it is believed that MS is often under-diagnosed or misdiagnosed in this population.
MS symptoms may mimic those of other conditions and may differ in severity, depending on where the damage occurs in the central nervous system.
Tingling, numbness and sensations of tightness or weakness may result when myelin in the spinal cord is damaged. Damage to the cerebellum portion of the brain may result in imbalance or a lack of coordination.
Because MS can cause a wide variety of symptoms, doctors frequently struggle to diagnose the disease. Common symptoms in children include:
- Bladder or bowel control problems
- Clumsiness or weakness
- Difficulty walking or maintaining balance
- Dizziness or vertigo
- Eye problems, such as double vision or uncontrolled eye movements. Also, a sudden loss of vision is often a telltale sign of MS in children.
- Muscle stiffness or spasms
- Slurred speech
- Tingling or numbness in body parts
Some children also experience cognitive impairments related to the disease, which may range in severity. These include difficulty with concentration, attention and memory, which may affect a child's academic performance.
An early diagnosis of multiple sclerosis (MS) is critical in the management of your child's disease and quality of life. Research has shown that adults who receive an early diagnosis and begin prompt treatment experience fewer relapses and are less likely to develop disability.
To diagnosis MS, your child's doctor will conduct a thorough physical examination, asking about symptoms your child is experiencing, including when they started and how they've eased or progressed over time. Your child's doctor will record a full medical history, including information about your immediate and extended family's medical history.
A series of tests may be conducted, including magnetic resonance imaging (MRI). Over the past two decades, the number of children and adolescents diagnosed with MS has risen significantly, due in part to the use of MRI in the diagnosis of the disease.
If it is suspected that your child has MS, he or she will have a MRI of the brain or spinal cord to look for lesions that may indicate MS. An MRI scan is a non-invasive procedure that uses powerful magnets and radio waves to construct clear, detailed pictures of brain and spinal cord tissues.
Other tests may be conducted to make a definite diagnosis and rule out other disorders that may mimic MS. These include:
- Blood and urine tests to help rule out other possible disorders.
- Evoked potentials test, which records electrical activity in the brain when nerves are stimulated (visual, brainstem or somatosensory evoked potentials).
- Lumbar puncture or spinal tap to determine if there are abnormalities in the cerebrospinal fluid suggestive of inflammation — a sign of MS.
Children and adolescents with multiple sclerosis (MS) receive treatment at our Pediatric Multiple Sclerosis Center. Our team works with each patient to develop a treatment plan, including long-term follow-up care specifically tailored to his or her needs.
When necessary, we collaborate with other specialists at UCSF or elsewhere to ensure that your child receives the most comprehensive care possible.
Because we are part of an international network of six pediatric MS centers sponsored by the National Multiple Sclerosis Society, we have access to the latest information, research and treatments.
Currently, there is no cure for MS, although medications are available to help control the disease or slow its course. These medications have not been formally evaluated in patients under the age of 18, but these drugs help control the disease in adults and appear well tolerated in children and adolescents. Treatments include drugs that help children recover from MS flare-ups and that prevent MS flare-ups.
Treatments may include one of the following medications:
- Beta Interferon — A group of drugs that help fight viral infection and regulate the immune system. In adult MS, beta Interferon reduces the rate of relapses.
- Glatiramer Acetate — A drug that is believed to work by blocking the immune system's attack on myelin. In adults, glatiramer acetate also reduces the rate of relapses.
- Immunosuppressive Drugs — Drugs to suppress or control the immune system.
- Intraveinous Immunoglobulins — These drugs restore the balance in the antibody network of the immune system.
- Methylprednisolone — These are high dose steroids that help prompt recovery from MS relapses.
- Plasma Exchange — These drugs work to clear the blood from unwanted molecules, such as pathogenic antibodies.
You child may receive other medications to treat or control the symptoms of MS such as fatigue, pain, spasticity and tremors. His or her treatment may also include physical therapy, speech therapy and psychotherapy.
A regular exercise program that includes walking, swimming, stretching or riding a stationary bike can reduce some of your child's symptoms. Our physical therapists and staff can help your child improve walking ability, balance, range of motion and stamina.
UCSF Benioff Children's Hospitals medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your child's doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your child's provider.
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