Children with MS, like most adults with MS, will present with discrete attacks of new neurologic symptoms which appear over the course of hours to days, but will typically partially or completely improve over the course of a few days to weeks, especially if treated early and aggressively. While older children may have similar clinical symptoms to adults, commonly including either painful blurring or loss of vision in one eye, double vision and weak eye movements, shooting facial pain, weakness or sensory loss in a limb or one side of the body or face, or clumsiness and loss of coordination, children may present with more complex symptoms such as acute decreased mental status, blurring or loss of vision in both eyes, lethargy, fatigue, rarely seizures, and combinations of symptoms which typically would present in isolation in older patients [1,2,]. These ‘polysymptomatic’ attacks may resemble other unrelated but similar demyelination disease in childhood, including acute demyelinating encephalopmyelitis, neuromyelitis optica, optic neuritis, and acute transverse myelitis, and these atypical presenting symptoms in children may make it difficult to recognize the onset of multiple sclerosis initially [3,4,]. Relapsing attacks are known to occur more frequently in children than in adults. However, the symptoms of relapses are more likely to fully improve in younger children than in adults after the attacks remit. Over time, incomplete improvement in the symptoms acquired in disease relapses may leave patients with persistent and permanent neurological deficits, leading to increasing disabilities which are left after each successive cycle of relapse and remittance. Relapse frequency and disease progression may be higher in children with minority ancestry, compared to children of northern European ancestry. Less than 2% of children will present with a progressive course of increasing disability from the onset of disease, independent of discrete clinical disease relapses [5].
Cognition and mood
Cognitive functioning and mood related difficulties are common in pediatric multiple sclerosis (MS). Defects in memory, complex attention and processing speed and, sometimes, language, are found in nearly 30% of children with MS. Mood disturbance, in particular depressive symptoms and behavioral problems, can be associated with cognitive difficulties and are also increasingly recognized in children with MS.
As in adults with MS, cognitive problems can be detected from the early stages of the disease – unrelated to the level of physical disability – and can have a negative impact on lifestyle, current and future school achievements, and quality of life.
Cognitive rehabilitation may enhance brain plasticity in these young children. This should be a key focus in this area of research.
Read a recent IPMSSG article on cognition and mood.
Read a summary of a recent IPMSSG workshop, “Cognition – How Can We Help?” The workshop focused on what are the cognitive issues, clinical and neuroimaging correlates, longitudinal studies, unmet needs, future research perspectives, assessment challenges in different settings, and the role of fatigue and depression.
References
- Kennedy, J. et al. Age at onset of multiple sclerosis may be influenced by place of residence during childhood rather than ancestry. Neuroepidemiology 26, 162-167 (2006).
- Ghezzi, A. et al. Multiple sclerosis in childhood: clinical features of 149 cases. Mult. Scler. 3, 43-46 (1997).
- Boiko, A et al. Early onset multiple sclerosis: a longitudinal study. Neurology 59, 1006-1010 (2002).