While commonly thought of as a disease that affects adults, multiple sclerosis (MS) also occurs in children.
Learn more about pediatric MS from Dr. Nick Brenton, a UVA pediatric neurologist who specializes in pediatric MS.
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Multiple Sclerosis in Children
Featured Speaker:
Nick Brenton, MD
Dr. Nick Brenton is a board-certified pediatric neurologist who specializes in pediatric multiple sclerosis and pediatric epilepsy.Learn more about UVA Children’s Hospital and UVA Neurosciences Center
Transcription:
Multiple Sclerosis in Children
Melanie Cole (Host): Commonly thought of as a disease that affects adult, multiple sclerosis also can occur in children. How would you know that this is what your child is going through? What help is out there for a pediatric multiple sclerosis patient? My guest today is Dr. Nick Brenton. He’s board certified in pediatric neurology who specializes in pediatric multiple sclerosis and pediatric epilepsy. Welcome to the show, Dr. Brenton. Most people think of MS as a disease that affects adults but really how common is it in children?
Dr. Nick Brenton (Guest): Thank you for having me. MS is actually… it’s very true many pediatricians and pediatric subspecialists are still surprised when I tell them that MS can occur in children. We think about MS all comersto children and adults. The average estimate is about 2.3 million people are affected by MS worldwide, and though we traditionally think of MS as a disorder of young adults and adults, it’s becoming increasingly identified in kids. The estimates now say that up to 10.5 percent of patients have clinical onset of symptoms of multiple sclerosis before the age of 18 years old.
Melanie: Wow, what are those symptoms? What would a parent notice or what would a child say to their parents that would spark a little bit of an alert or a red flag?
Dr. Brenton: Absolutely. It’s difficult especially in kids because kids are, in general, not as good as adults about reporting their symptoms. A lot of kids try to ignore them at first and see if they go away. Now, a first attack of MS can manifest in many different ways and it often comes on in a sub-acute nature and I mean that it’s not like it can go like a stroke typically where the symptoms come on like lightning and they stay. It’s more of symptoms gradually come on over the course of several hours and they escalate over the course of one or two days. They don’t tend to fluctuate and they don’t tend to stick around for an hour or two and then leave and then come back five hours later. Examples of first attacks in kids include something called optic neuritis. It’s inflammation of the nerve that sends our visual information to our brain, and so the symptoms can be visual blurring, a child complaining that their vision is blurry and it was perfect five minutes ago. Difficulty noticing colors especially red, they don’t have the color sensitivity as much. They also may complain of pain with eye movements. Other visual abnormalities like double vision or what we doctors call diplopia where they’re seeing two of an object. It shouldn’t be two; it should just be one. Sometimes kids can present with symptoms of what we call transverse myelitis, which is where there’s an attack on their spinal cord and that patient may become progressively weak in their arms or legs or they may have sensory changes, feeling numb or tingling in parts of their body that doesn’t go away. Or they may have bowel or bladder issues, difficulty holding in or difficulty letting out urine or feces. Then another thing that can be seen is balance difficulties. The child has difficulty walking in a straight line. A lot of parents have told me that they noticed their child was walking like they were drunk, running into things. Those are also symptoms that if they persist, it could be concerning for a first attack of multiple sclerosis.
Melanie: If they’ve had that first attack and how scary for both the child and the parents, then what do you do? You go see a pediatric neurologist; it gets diagnosed. What are the treatments? What is the outlook like for this child?
Dr. Brenton: Absolutely. Depending on how that first attack presents, there are a few treatments to help make the symptoms go away quicker. The natural history is that with their first attack of MS, children are very good about repairing and healing from that event without any treatment usually. Now sometimes if the event is bad enough, and most of the times, there are some things that are worrisome enough that we opt to treat. We can give medicines like IV steroids to help to speed up their recovery. Now the steroids we don’t think makes them better than if they wouldn’t have gotten steroids, but we do think that it speeds us their body’s recovery. Now after they get diagnosed with MS, there are no cures for multiple sclerosis as of right now, but there are treatments to help with the disease and make the disease quieter and not as active. Standard accepted therapies in pediatric MS come in the form of injections. Your injections are either subcutaneous or into the muscle and they can be given as frequently as daily to as infrequently as every other week. These are medicines that we call immunomodulators, meaning that they help turn down the kid’s overactive immune system which is why we think they developed multiple sclerosis. The injections have been available for over 20 years and they’ve proven to be safe, well tolerated, and they have a very good side effect profile. Additionally, their therapeutic benefits have been shown in multiple studies to reduce the attacks of MS on the brain.
Now as some people may know, there are now three oral medicines out there that have been approved by the FDA to treat adult-onset multiple sclerosis since 2010. Now the problem with these medicines—because as you can imagine, a lot of kids want the oral medicines before the injectables—my problem with that is that we don’t know the safety of these oral medicines in kids yet because they are so new. But it is an exciting time for the pediatric MS community because there are multiple international clinical trials that are currently underway to evaluate the safety and efficacy of these newer emerging therapies for pediatric-onset MS, and UVA plans to be part of this international collaboration in these clinical trials.
Melanie: If a child is diagnosed or a teenager with MS—and this is just in your opinion, Dr. Brenton—when you look towards their future life, can you give them hope to say, “Yes, you can manage this and you can go on to get married, have children. This may be not quite the bleak outlook it once was.”
Dr. Brenton: Absolutely. I think that’s probably my most important job. When you get a diagnosis of multiple sclerosis, it’s fraught with a stigma that these children are going to be in wheelchairs early on in their life and they’re not going to live a full, long, healthy life. The disease landscape with MS is changing as we get better and better treatment. It’s amazing that we’ve had four, actually five, new treatments approved since 2010 for multiple sclerosis. That is a relief that we’re coming out with therapies in the MS community that has never been seen before. Yes, when I see these kids, I definitely have to encourage them and advise them that I want them to continue with their future just as planned. These kids aren’t like adults because they’re going through a different part of their lives. The psychology behind the diagnosis is so much different in children and adolescents than it is in an adult because they are in school, they may be in college, and they’re at the point in their lives where they’re really looking to just fit in. A chronic disease, like multiple sclerosis, really screws that out. So it’s my job as the pediatric neurologist to make sure that we don’t let MS get in the way of them doing what they want to do as much as possible.
Melanie: That’s really great information and great hope. In just the last few minutes, why should families come to UVA for their MS care?
Dr. Brenton: Pediatric MS is rare enough that many child neurologists don’t feel that they see it enough to be absolutely comfortable in treating the disorder. Adult neurologists who see MS much more realize that the differential diagnosis of a child who presents with symptoms of MS is much more different than that of an adult. Given all of these reasons, I’m more excited to bring this especially to UVA so that the children in Virginia and the bordering states don’t have to travel too far to see a pediatric neurologist who specializes in multiple sclerosis. Our clinic is held right now once a week and it features a multidisciplinary team. All of these people are part of this team that is geared specifically for meeting the needs of pediatric and adolescent patients with multiple sclerosis. These team members include physical and occupational therapists. It includes a social worker and also includes a pediatric neuropsychologist. We know that up to one-third of kids with MS can have cognitive impairment towards the onset of the disease, so a pediatric neuropsychologist is a very important piece to having this clinic and then we have the pediatric neurologist who works to treat the disease. So we’re very excited to have this opportunity to offer this to the children of Virginia and very excited to be a part of the UVA community.
Melanie: Thank you so much, Dr. Nick Brenton. You are listening to UVA Health Systems Radio. For more information on the UVA Children’s Hospital and UVA Neurosciences Center, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
Multiple Sclerosis in Children
Melanie Cole (Host): Commonly thought of as a disease that affects adult, multiple sclerosis also can occur in children. How would you know that this is what your child is going through? What help is out there for a pediatric multiple sclerosis patient? My guest today is Dr. Nick Brenton. He’s board certified in pediatric neurology who specializes in pediatric multiple sclerosis and pediatric epilepsy. Welcome to the show, Dr. Brenton. Most people think of MS as a disease that affects adults but really how common is it in children?
Dr. Nick Brenton (Guest): Thank you for having me. MS is actually… it’s very true many pediatricians and pediatric subspecialists are still surprised when I tell them that MS can occur in children. We think about MS all comersto children and adults. The average estimate is about 2.3 million people are affected by MS worldwide, and though we traditionally think of MS as a disorder of young adults and adults, it’s becoming increasingly identified in kids. The estimates now say that up to 10.5 percent of patients have clinical onset of symptoms of multiple sclerosis before the age of 18 years old.
Melanie: Wow, what are those symptoms? What would a parent notice or what would a child say to their parents that would spark a little bit of an alert or a red flag?
Dr. Brenton: Absolutely. It’s difficult especially in kids because kids are, in general, not as good as adults about reporting their symptoms. A lot of kids try to ignore them at first and see if they go away. Now, a first attack of MS can manifest in many different ways and it often comes on in a sub-acute nature and I mean that it’s not like it can go like a stroke typically where the symptoms come on like lightning and they stay. It’s more of symptoms gradually come on over the course of several hours and they escalate over the course of one or two days. They don’t tend to fluctuate and they don’t tend to stick around for an hour or two and then leave and then come back five hours later. Examples of first attacks in kids include something called optic neuritis. It’s inflammation of the nerve that sends our visual information to our brain, and so the symptoms can be visual blurring, a child complaining that their vision is blurry and it was perfect five minutes ago. Difficulty noticing colors especially red, they don’t have the color sensitivity as much. They also may complain of pain with eye movements. Other visual abnormalities like double vision or what we doctors call diplopia where they’re seeing two of an object. It shouldn’t be two; it should just be one. Sometimes kids can present with symptoms of what we call transverse myelitis, which is where there’s an attack on their spinal cord and that patient may become progressively weak in their arms or legs or they may have sensory changes, feeling numb or tingling in parts of their body that doesn’t go away. Or they may have bowel or bladder issues, difficulty holding in or difficulty letting out urine or feces. Then another thing that can be seen is balance difficulties. The child has difficulty walking in a straight line. A lot of parents have told me that they noticed their child was walking like they were drunk, running into things. Those are also symptoms that if they persist, it could be concerning for a first attack of multiple sclerosis.
Melanie: If they’ve had that first attack and how scary for both the child and the parents, then what do you do? You go see a pediatric neurologist; it gets diagnosed. What are the treatments? What is the outlook like for this child?
Dr. Brenton: Absolutely. Depending on how that first attack presents, there are a few treatments to help make the symptoms go away quicker. The natural history is that with their first attack of MS, children are very good about repairing and healing from that event without any treatment usually. Now sometimes if the event is bad enough, and most of the times, there are some things that are worrisome enough that we opt to treat. We can give medicines like IV steroids to help to speed up their recovery. Now the steroids we don’t think makes them better than if they wouldn’t have gotten steroids, but we do think that it speeds us their body’s recovery. Now after they get diagnosed with MS, there are no cures for multiple sclerosis as of right now, but there are treatments to help with the disease and make the disease quieter and not as active. Standard accepted therapies in pediatric MS come in the form of injections. Your injections are either subcutaneous or into the muscle and they can be given as frequently as daily to as infrequently as every other week. These are medicines that we call immunomodulators, meaning that they help turn down the kid’s overactive immune system which is why we think they developed multiple sclerosis. The injections have been available for over 20 years and they’ve proven to be safe, well tolerated, and they have a very good side effect profile. Additionally, their therapeutic benefits have been shown in multiple studies to reduce the attacks of MS on the brain.
Now as some people may know, there are now three oral medicines out there that have been approved by the FDA to treat adult-onset multiple sclerosis since 2010. Now the problem with these medicines—because as you can imagine, a lot of kids want the oral medicines before the injectables—my problem with that is that we don’t know the safety of these oral medicines in kids yet because they are so new. But it is an exciting time for the pediatric MS community because there are multiple international clinical trials that are currently underway to evaluate the safety and efficacy of these newer emerging therapies for pediatric-onset MS, and UVA plans to be part of this international collaboration in these clinical trials.
Melanie: If a child is diagnosed or a teenager with MS—and this is just in your opinion, Dr. Brenton—when you look towards their future life, can you give them hope to say, “Yes, you can manage this and you can go on to get married, have children. This may be not quite the bleak outlook it once was.”
Dr. Brenton: Absolutely. I think that’s probably my most important job. When you get a diagnosis of multiple sclerosis, it’s fraught with a stigma that these children are going to be in wheelchairs early on in their life and they’re not going to live a full, long, healthy life. The disease landscape with MS is changing as we get better and better treatment. It’s amazing that we’ve had four, actually five, new treatments approved since 2010 for multiple sclerosis. That is a relief that we’re coming out with therapies in the MS community that has never been seen before. Yes, when I see these kids, I definitely have to encourage them and advise them that I want them to continue with their future just as planned. These kids aren’t like adults because they’re going through a different part of their lives. The psychology behind the diagnosis is so much different in children and adolescents than it is in an adult because they are in school, they may be in college, and they’re at the point in their lives where they’re really looking to just fit in. A chronic disease, like multiple sclerosis, really screws that out. So it’s my job as the pediatric neurologist to make sure that we don’t let MS get in the way of them doing what they want to do as much as possible.
Melanie: That’s really great information and great hope. In just the last few minutes, why should families come to UVA for their MS care?
Dr. Brenton: Pediatric MS is rare enough that many child neurologists don’t feel that they see it enough to be absolutely comfortable in treating the disorder. Adult neurologists who see MS much more realize that the differential diagnosis of a child who presents with symptoms of MS is much more different than that of an adult. Given all of these reasons, I’m more excited to bring this especially to UVA so that the children in Virginia and the bordering states don’t have to travel too far to see a pediatric neurologist who specializes in multiple sclerosis. Our clinic is held right now once a week and it features a multidisciplinary team. All of these people are part of this team that is geared specifically for meeting the needs of pediatric and adolescent patients with multiple sclerosis. These team members include physical and occupational therapists. It includes a social worker and also includes a pediatric neuropsychologist. We know that up to one-third of kids with MS can have cognitive impairment towards the onset of the disease, so a pediatric neuropsychologist is a very important piece to having this clinic and then we have the pediatric neurologist who works to treat the disease. So we’re very excited to have this opportunity to offer this to the children of Virginia and very excited to be a part of the UVA community.
Melanie: Thank you so much, Dr. Nick Brenton. You are listening to UVA Health Systems Radio. For more information on the UVA Children’s Hospital and UVA Neurosciences Center, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.