Multiple sclerosis in children

This chapter discusses epidemiology, pathophysiology, clinical features, investigations, and treatment of multiple sclerosis (MS). Genetic risk factors for MS remain an important area of study. Viral exposures play an important role in the risk for developing MS in children. As in adult MS, active demyelinating lesions are accompanied by mononuclear cell infiltrates and macrophages in a perivascular distribution. Pediatric MS is nearly always relapsing-remitting. A thorough ophthalmological examination, including optical coherence tomography (OCT) and possibly visual evoked potentials, may help to elucidate evidence of past optic neuritis. The basic treatment of pediatric MS parallels that of adult patients. Clinical trials of disease-modifying treatments in children with MS are just now getting underway. Ophthalmology involvement is essential to detect changes that may be associated with optic neuritis. Diagnostic criteria of MS in children are now well established, with approximately 3000 pediatric MS patients currently identified worldwide.