Professor Folker A. Hanefeld, MD, Neurologist, Georg-August-University, Göttingen, Germany

When MS was “discovered” in 1874 there were doubts regarding the existence of the disease in childhood, and for almost 50 years the existence of childhood MS before the age of ten years was ignored or denied. However, with the advent of modern research techniques it became possible to differentiate between various causes of demyelination, which helped build the case for the possibility that a child could indeed develop MS. Although, so far as is known today, true childhood MS and juvenile onset MS are both quite rare.

Currently the diagnosis of MS in children follows different criteria to that for adults since magnetic resonance imaging is more difficult to interpret in children and therefore information obtained is less certain than with adults. Based on this, a correct diagnosis requires the elimination, through testing, of many other types of diseases and disorders with symptoms similar to MS.

An important study, which began in 1989 in Göttingen, Germany, includes only children with symptoms beginning before 15 years of age, and has provided the MS community with important information on childhood MS. The study identified two types of childhood MS:
- Children in whom the disease started before puberty (10 years); this is classified as true childhood MS
- Juvenile MS (onset between 10 and 15 years of age)

Study results
Amongst the children with early symptoms before puberty, boys and girls are equally affected. Amongst juvenile cases the female to male ratio becomes 2:1 as in adult MS. In 54 per cent of cases a single symptom was observed at the onset of MS. While in 46 per cent of cases multiple symptoms were noted.

There was no evidence for a definitive association between vaccination or any specific childhood disease and the development of MS. Interestingly, the study found that in more than half of the children a non-specific infection, usually of the upper respiratory tract, occurred before the beginning of the disease or a new relapse.

The future for children with MS
This ongoing study will continue to provide new information. Although we are certain that childhood MS does exist, there are still many questions remaining to be answered by research. Meanwhile, an early and correct diagnosis is very important for every patient. In children it carries far-reaching implications for their futures.

The important issues that accompany the diagnosis of MS in childhood for the child and family include:
• understanding the nature of the disease
• coping with disabilities, both potential and real
• schooling and education
• choices for professional life
• partnership and family planning

It is also important that healthcare professionals should educate parents of children with MS about vaccination and immunization. Several MS specialists have suggested that:
• immunization should be postponed during an acute episode or attack
• live vaccines should not be administrated to children receiving steroids or immunosuppressive treatment
• an interval of at least three months before administering vaccination or immunization after immunosuppressive therapy is recommended
• children should receive immunoglobulins after exposure to measles or chicken pox or other highly infective agents if they have not been protected by prior immunization
• oral poliomyelitis vaccine should not be given to siblings or others in the household during immunosuppressive therapy

Other information and recommendations on vaccination and immunization can be obtained from an MS specialist or national MS Society.

The number of early, well-documented cases with true childhood MS is still very small and only time will tell how their disease will develop during adult life. Ongoing information and support is vital for the child with MS and for the family.