Multiple sclerosis (MS)

What is multiple sclerosis?

Multiple sclerosis (MS) is a chronic inflammatory disease that affects the central nervous system, including the brain, spinal cord and optic nerves. It's considered an autoimmune disease, which means it occurs as a result of the body's immune system attacking and damaging its own nervous system.

Although MS is most commonly diagnosed in young adults, it can also affect babies, children and adolescents. Up to 5% of people with MS experience symptoms before age 18. Due to a general lack of awareness of pediatric MS, experts believe the condition is often underdiagnosed or misdiagnosed in this population.

MS damages the outer covering of nerve cells, a fatty tissue called myelin that protects nerve cells 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.

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.

Our approach to MS

At UCSF's Benioff Children's Hospitals, our Pediatric Neuro-Immunology and Multiple Sclerosis Program is dedicated to improving diagnosis, treatment, and awareness of children and adolescents with MS and related diseases. It's one of the few centers 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.

Causes of multiple sclerosis

The cause of MS is not yet known. Inflammation, infections, exposure to certain poisons, and drugs may damage the myelin sheath, but none of these factors has been identified as causing the disease.

Heredity also may be a factor. About 5% of patients have a sibling with MS and about 15% have a close relative with the disease, although a specific MS gene abnormality hasn't been identified. In addition, environmental factors might be involved, as MS incidence significantly varies with geographical latitude.

Symptoms of multiple sclerosis in kids

MS symptoms vary depending on where in the central nervous system the damage occurs. For instance, when myelin in the spinal cord is damaged, tingling, numbness and sensations of tightness or weakness may result. Damage to the cerebellum portion of the brain may result in balance problems or a lack of coordination.

Because MS causes 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, uncontrolled eye movements or (a telltale sign of MS in children) sudden loss of vision
• Fatigue
• Muscle stiffness or spasms
• Slurred speech
• Tingling or numbness in body parts
• Tremors

Cognitive impairment and emotional disorders

Some children with MS also experience cognitive impairments, which range in severity. These include difficulty with concentration, attention and memory, and may affect the child's academic performance.

Mood disorders, such as depression, anxiety and bipolar disorder, are common among people living with MS. This may be due to physical changes in the brain, medications used to treat MS or challenging life events.

MS can also cause affective disorders, or changes in how people express emotion. One of the most common is pseudobulbar affect, in which the person laughs or cries suddenly and uncontrollably for no reason.

Conditions that mimic MS

Many conditions can cause the same symptoms as multiple sclerosis. These include:

• Autoimmune disorders, such as lupus, neuromyelitis optica, acute disseminated encephalomyelitis (ADEM) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD)
• Rare genetic disorders called leukodystrophies
• Infections, such as Lyme disease and West Nile virus
• Vitamin deficiencies, such as low levels of B12 and folate
• Cancers, such as lymphoma

Your child's doctor may order tests to rule out these and other conditions.

Diagnosis of multiple sclerosis

An early diagnosis of multiple sclerosis is critical to managing your child's disease and quality of life. Research has shown that adults who receive an early diagnosis and begin treatment promptly experience fewer relapses and are less likely to develop disability.

To diagnosis MS, the doctor will conduct a thorough physical examination, asking about your child's symptoms, including when they started and how they've eased or progressed over time. Your child's doctor will take a full medical history, including information about your immediate and extended family's health history.

If MS is suspected, your child will have a brain or spinal cord MRI to check for lesions that may indicate the condition. An MRI is a noninvasive scan that uses powerful magnets and radio waves to construct clear, detailed pictures.

Additional tests may be done to rule out other disorders and make a definitive diagnosis. These include:

• Blood and urine tests.These can check for other conditions that may be causing your child's symptoms.
• Evoked potentials test. Electrical activity in the brain is recorded as nerves are stimulated (visual, brain stem or somatosensory evoked potentials).
• Lumbar puncture. Also called a spinal tap, this test uses a sample of cerebrospinal fluid to look for abnormalities that suggest inflammation, which is a sign of MS.

Treatment of multiple sclerosis

Children and adolescents with MS receive specialized treatment at our Pediatric Neuro-Immunology and Multiple Sclerosis Program. Our team works with each patient to develop a care plan, including long-term follow-up tailored to their specific needs. When necessary, we collaborate with other specialists at UCSF or elsewhere to ensure all children receive the most comprehensive care possible.

As part of an international network of 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 drugs haven't been formally evaluated in patients under 18, but they help manage the disease in adults and appear well tolerated in children and adolescents. Some of these drugs help patients recover from MS flare-ups and others can prevent the flare-ups.

MS treatments include:

• Beta interferon drugs. These medications help fight viral infection and regulate the immune system. In adults with MS, beta interferon reduces the rate of relapses.
• Glatiramer acetate. This drug is believed to work by blocking the immune system's attack on myelin. In adults, glatiramer acetate also reduces the relapse rate.
• Immunosuppressants. These drugs subdue or control immune system activity.
• Intravenous immunoglobulins. These drugs restore balance in the immune system's antibody network.
• Methylprednisolone. This steroid can induce recovery from MS relapses.
• Plasma exchange. This procedure can be used to clear the blood of harmful molecules, such as pathogenic antibodies.

Your child may receive other medications to treat or control MS symptoms, such as fatigue, pain, spasticity and tremors. The treatment plan may also include physical therapy, speech therapy and psychotherapy (talk therapy).

A regular exercise program may reduce some of your child's symptoms. Our physical therapists can work with your child to improve their walking ability, balance, range of motion and stamina.