What is the prognosis of pediatric multiple sclerosis (MS)?

Updated: Jan 30, 2019
  • Author: Alice K Rutatangwa, DO, MSc; Chief Editor: Amy Kao, MD  more...
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Answer

The psychosocial complications of pediatric MS encompass various problems, including feelings of self-consciousness, worries related to the future, problems with family and friends, mood disorders, and cognitive impairment.

The Schedule for Affective Disorders and Schizophrenia for School-Age Children—Present and Lifetime Version (KSADS) [24] revealed that approximately 30%-48% of children with MS or related conditions have affective disorders. [25] The most common psychiatric conditions include major depression, anxiety disorder, a combination of anxiety and depressive disorders, panic disorder, bipolar disorder, and adjustment disorder.

When the scores from the pediatric MS group were compared to age-matched healthy controls and the fifth percentile of the healthy controls was used as the cutoff for fatigue, a total of 73% of the pediatric MS group met this criterion for severe fatigue. [25]

Cognitive impairment occurs in an estimated 30%–75% of children with MS depending on which definition of impairment is applied and at what point in their course the children undergo evaluations. [25, 26, 26, 24] Similar to prior reports, the domains more frequently affected included memory, complex attention, verbal comprehension, and executive functioning. Younger age at symptom onset correlated with lower intelligence quotient (IQ) scores. [25, 27]

Children with MS appear to be more vulnerable to cognitive decline over short periods than adults with MS. In school-aged children, cognitive decline is demonstrated by poor school performance. A significant percentage of pediatric patients with MS require some type of help or altered school curriculum owing to cognitive impairments, and up to 14% are homeschooled because of their illness. Some children need classroom seating accommodations, tutoring, and in-class assistance with implementation of 504 or individualized education plans.

Disability scores are lower in pediatric patients than in adults, even when adjusted for disease duration. The median time to reach an Expanded Disability Status Scale (EDSS) score of 4 (defined as a visible, often irreversible, neurologic deficit in a patient who is still able to ambulate at least 500 meters without assistance) was approximately 20 years in pediatric MS versus 10 years in adult MS. [28] Thus, despite a slower development of irreversible disability in patients with pediatric MS, the age when these patients are confronted with disease progression and neurological deficits is 10 years younger than the population with adult-onset MS, at the time when they are expected to have a family and enter the workforce. [29]


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