There is increasing appreciation that multiple sclerosis (MS) can begin in childhood or adolescence, but pediatric MS continues to be a rare entity, with an estimated 2 to 5% of patients with MS experiencing their first clinical symptoms before age 16. A prompt diagnosis of pediatric MS is important to optimize overall management of both the physical and social impact of the disease. The widespread use of disease-modifying therapies (DMT) for MS in adults, as early as following an initial isolated episode, has led to the use of DMT in children and adolescents with MS. However, it is imperative to distinguish pediatric MS from other childhood CNS inflammatory demyelinating disorders such as acute disseminated encephalomyelitis. Although increasing evidence suggests a slower disease course in children with MS compared to adults, significant disability can still accumulate by early adulthood. Furthermore, associated neurocognitive deficits can impair both academic and psychosocial function at a critical juncture in a young person's life. This article reviews the clinical characteristics, neuroimaging, paraclinical findings, disease course, epidemiology, genetics, and pathophysiology of pediatric MS vis-à-vis adult MS. Further research of pediatric MS may advance our understanding of MS pathophysiology in general, as well as improve the long-term health care outcomes of children and adolescents diagnosed with MS.

Background Approximately one-third of those with pediatric-onset MS experience cognitive impairment. Less is known concerning their change in cognitive functioning over time. Objective Changes in cognitive function over time were measured in the largest pediatric cohort to date through the U.S. Network of Pediatric MS Centers. Methods 67 individuals with pediatric MS (n=62) or clinically isolated syndrome (CIS, n=5), ranging from 8 to 17 years of age (mean age ± SD = 14.37 ± 2.02) completed initial and followup neuropsychological testing after an average of 1.64 ± 0.63 years. The nine tests administered measure general intellect, attention and working memory, verbal memory, visuomotor integration, language, and executive functioning. Results Rate of impairment (having one-third or more scores in the impaired range) was 37% at baseline and 33% at follow-up. Tests commonly impaired were measures of visuomotor integration, speeded processing, and attention. Most tested did not decline over two years. There was no clear pattern of change on specific measures. Conclusion Findings suggest that over short timeframes, stable or even improved performances on measures of cognitive ability can occur. Rather than leading to decline, pediatric MS may instead prevent expected age-related gains.

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