Multiple Sclerosis (MS) and Neuromyelitis Optica (NMO)

MS and NMO are autoimmune diseases where the body's immune system reacts against itself and attacks its own healthy cells and tissue. Specifically, the immune system attacks the central nervous system’s myelin, the protective coating around nerve cells. Attacks on myelin create areas of inflammation throughout the central nervous system, which slow or interrupt the flow of information that move via the nerve cells, resulting in MS symptoms.

There are several different types of multiple sclerosis (MS):

• Relapsing-Remitting Multiple Sclerosis (RRMS): Most children with MS are diagnosed with this type. It’s also the most common form of MS. People with RRMS will have attacks (relapses) of symptoms that go away and come back later.
• Primary Progressive Multiple Sclerosis (PPMS): People with this type of MS have chronic symptoms that steadily get worse over time.
• Secondary Progressive Multiple Sclerosis (SPMS): With this type of MS, symptoms steadily get worse. Most people who have RRMS eventually develop SPMS.

While MS is more often diagnosed in adults between the ages of 20 and 40, children can also develop the autoimmune disease. NMO presents more commonly in childhood.

Causes

MS occurs when there is damage to the myelin (protective coating surrounding nerve fibers) in the central nervous system. The damaged or inflamed myelin then interferes with the transmission of nerve signals between the brain, spinal cord, and other parts of the body.

While it is difficult to determine the exact cause of MS in most people, some cases are thought to be caused by genetics.

Other factors that could potentially damage the central nervous system and contribute to MS or other nervous system disorders in children include:

• Trauma
• Infections
• Degeneration
• Structural defects
• Tumors
• Blood flow disruption
• Autoimmune disorders
• Inborn genetic or metabolic problems
• Toxic exposures or direct effects of drug exposures

The cause of these conditions is still a mystery. Researchers believe several factors may play a role including genetics, issues with the immune system, and environmental factors.

Symptoms

MS symptoms are variable and unpredictable, and no two children’s symptoms are identical. Symptoms in patients can also fluctuate at times or disappear altogether, while new ones crop up or others remain permanent.

The most common symptoms of nervous system disorders like MS in children are:

• Delays in developmental milestones
• Increase or lack of growth in head size
• Changes in activity, reflexes, or movements
• Lack of coordination
• Changes in the level of consciousness or mood
• Muscle rigidity, tremors, or seizures
• Muscle wasting and slurred speech
• Persistent or severe headaches
• Loss of feeling or tingling
• Changes in vision

MS and NMO symptoms are different in each person. Some may experience a couple of symptoms, while others may experience many. Therefore, treatments are often customized to each patient.

Diagnosis

Before diagnosing MS, a complete physical exam is needed to rule out any other medical conditions, along with a review of your child’s family medical history. A neurological exam, most likely an MRI (magnetic resonance imaging), and a spinal fluid analysis (or spinal tap) may also be ordered.

To determine if your child has MS, our staff will review your medical history and specific details about symptoms experienced. An official diagnosis of MS follows evidence of damage found in at least two separate central nervous system areas, including the brain, spinal cord, and optic nerves.

Treatment

There is no cure for MS and NMO. Treatment is focused on controlling the immune system and helping manage symptoms. Because symptoms vary for each patient, following a thorough medical evaluation, a CNCA provider will develop an individualized care plan to meet the patient’s specific needs.

There are medications available for children to help manage their MS symptoms. Also, a combination of physical, occupational, and/or speech therapies can be extremely beneficial. Helping your child maintain a sense of control over their physical capabilities, to the best extent possible, is very important. Support groups and counseling can help kids navigate the emotional and social issues they might encounter due to MS.