Management of pediatric multiple sclerosis

Introduction Pediatric multiple sclerosis (MS), defined as MS with an onset before 18 years of age, comprises 2–5% of MS cases.– Increasing information regarding specific clinical characteristics and treatment options for this young population has emerged in recent years. We will review these topics, with specific attention to the management of MS in children and adolescents. Definitions According to the International Pediatric MS Study Group (IPMSSG) definitions, published in 2007, pediatric MS may be diagnosed at any age below 18 following two clinical inflammatory-demyelinating episodes of the central nervous system (CNS), which are not classified as acute disseminated encephalomyelitis (ADEM), that are separated by at least 30 days. In addition, as in adult MS, brain MRI criteria (Barkhof criteria) can be used to meet the requirement for dissemination in space. The combination of an abnormal CSF (at least two oligoclonal bands (OCB) and/or an elevated IgG index) and two lesions on MRI, of which one must be in the brain, can also meet the dissemination in space criteria. The MRI may also be used to satisfy the criteria for dissemination in time following the initial clinical event, even in the absence of a new clinical demyelinating event; new T2-bright or gadolinium (Gd)-enhancing foci that must develop three or more months following the initial clinical event (McDonald criteria).