Comprehensive Pediatric Multiple Sclerosis and Neuroimmunology Program

MS is thought to be an autoimmune disorder in which the immune system attacks healthy tissue (myelin) in the central nervous system (CNS). The CNS consists of the brain, spinal cord and optic nerves. Because the myelin is attacked in MS, it is a "demyelinating" disorder. Once believed to be a disease of adults, MS is now being diagnosed more commonly in children. It is estimated that up to 10% of all patients with MS developed their first symptom before age 18. Most children with MS have what is known as relapsing-remitting MS, whereby attacks of symptoms (relapses) cause episodes of neurologic worsening and then these symptoms get better (remit). Symptoms of MS will vary depending on what part of the CNS is involved. Some common symptoms include blurred vision, double vision, numbness or tingling in the arms and legs, unsteady walk, weakness in the arms or legs, and fatigue. Treatment of MS is aimed at controlling the immune system and managing the symptoms of MS.

Acute demyelinating encephalomyelitis (ADEM) is an autoimmune condition that causes a brief but severe attack of swelling in the brain or spinal cord that damages the myelin. ADEM typically presents after a cold or viral infection. It can sometimes occur after a recent vaccination. Children are more likely than adults to have ADEM. Although symptoms may be severe, most children with ADEM recovery completely or nearly completely after an attack. Symptoms of ADEM can vary depending on the extent of the attack. Some common symptoms include fever, headache, confusion, weakness, walking impairment, and seizures. The main treatment for ADEM is a type of steroid medication but sometimes more immune-mediated treatment is necessary.

ADEM and MS can share common symptoms. They are both "demyelinating" disorders. An MRI can help differentiate between the two. Patients with MS usually require medication to prevent further attacks. ADEM usually only causes one attack and these patients typically do not need preventative medication.

Transverse myelitis is an autoimmune disorder. The immune cells, which usually fight infections, confuse your child's body, and start to fight healthy cells and tissue. In transverse myelitis, the immune cells attack the spinal cord. Transverse myelitis can be rarely seen after a vaccination. Symptoms of transverse myelitis include pain, weakness in the arms and/or legs, difficulty walking, numbness, tingling, and loss of bowel and bladder function. If the cervical portion of the spinal cord is affected, both the arms and the legs will be affected. In severe cervical cases, breathing can be involved. If the thoracic portion of the spinal cord is involved, the legs will be affected, but the arms won't. Transverse myelitis is treated with a steroid medication. Sometimes further immune-mediated treatment is necessary. Most children with transverse myelitis make a complete or near complete recovery. Motor function usually improves faster than bowel and bladder function. Some patients can have residual symptoms such as weakness, numbness, or urinary problems. Transverse myelitis usually occurs only once and does not require long term treatment. Occasionally transverse myelitis can be the initial presentation of MS.

Optic neuritis is an autoimmune condition in which your immune system attacks your optic nerve. Your optic nerve sends information to your brain about what you are seeing. Optic neuritis can affect one eye or both eyes. Symptoms of optic neuritis include pain with eye movements, blurred vision, and vision loss. Treatment of optic neuritis usually involves a steroid medication. Most patients with optic neuritis will make a complete or nearly complete recovery, though this can vary. Some children who initially have optic neuritis can later develop MS. Although this is rare, it is important to have ongoing follow up with your doctor. Most children with optic neuritis do not require preventative medication.

Neuromyelitis optica (NMO) is an autoimmune condition in which your immune system attacks your optic nerves and/or your spinal cord. NMO is a chronic condition, and much like MS, it can be relapsing and remitting. The symptoms of NMO depend on where the attacks occur but can include blurred vision, numbness, tingling, weakness, nausea, and hiccupping. Rarely, severe attacks can cause breathing problems. Most patients with NMO carry an auto-antibody in their blood that can lead to attacks. Treatment of NMO attacks usually involves a steroid medication. Some severe attacks require a procedure known as plasmapharesis whereby the auto-antibodies are removed from the blood. Treatment for prevention of attacks consists of taking an immunosuppressant medication.

Immune mediated encephalitis is an autoimmune condition in which your immune system attacks your brain. The symptoms of immune mediated encephalitis can include seizures, confusion, memory problems, sleepiness, changes in mood, and behavior, abnormal facial movements, and difficulty walking. In severe cases, there can be breathing difficulties. Certain types of this disorder can be associated with tumors. Treatment of immune mediated encephalitis includes medications aimed at controlling the immune system.

CNS vasculitis is an autoimmune condition in which your immune system attacks the blood vessels of the brain. Children with CNS vasculitis can present with headaches, stroke-like symptoms, seizures, numbness, tingling, and problems with fine motor activities. Treatment of CNS vasculitis includes medications aimed at controlling the immune system.

Other systemic inflammatory conditions such as lupus, sarcoidosis, and Behcet's disease may rarely cause problems in the brain and spinal cord. When this occurs, more aggressive treatment is usually required. We work closely with your rheumatologist to come up with the best individualized treatment plan. Treatment of CNS manifestations of systemic inflammatory disorders is aimed at controlling the immune system.