Faculty Bibliography

An increasing number of children and adolescents with multiple sclerosis (MS) are being identified and treated with disease-modifying therapies. Yet, there currently is little experience to guide clinicians. As more rapid diagnosis is made possible with magnetic resonance imaging, the number of pediatric MS patients requiring treatment will increase with time. This review draws on information from adult and pediatric neurology sources and summarizes current available data. Additional research is clearly needed. Nonetheless, there are several treatment principles: 1) establishing the diagnosis by differentiating MS from acute disseminated encephalomyelitis or recurrent acute disseminated encephalomyelitis; 2) emphasizing that there are parallels between adult and pediatric MS regarding the clinical presentation, disease course, and ability to tolerate therapy (the more extensive experience in adult MS can be applied to most pediatric cases); 3) explaining the importance of starting treatment early in the disease course and that these therapies seem well-tolerated in children; 4) providing reassurance that the family is not alone; as approximately 5% of the MS population has symptom onset before age 18 years (experience with pediatric MS is growing and centers with pediatric MS programs exist in other countries and are developing within the United States); and 5) reviewing symptom management and addressing issues such as academic performance that are unique to the pediatric MS subpopulation

OBJECTIVE: To examine cognitive functioning in children with multiple sclerosis (MS). METHODS: The authors examined the neuropsychological profile of 37 children with a diagnosis of clinically definite MS and assessed the associations between cognitive function and clinical features. RESULTS: Of 37 children and adolescents evaluated, 35% demonstrated significant cognitive impairment. Cognitive functioning was strongly related to several clinical variables, including current Expanded Disability Status Scale, total number of relapses, and total disease length. The consequences of MS adversely affected academic functioning in over a third of the children. CONCLUSIONS: Cognitive deficits occur in children with multiple sclerosis. Comprehensive treatment planning should involve recognition that they may require academic accommodations for their education