Transcription:
Pediatric Multiple Sclerosis

Melane Cole (Host): There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels. Welcome to Kids' Health Cast by Weill Cornell Medicine. I'm Melanie Cole. And today, we're speaking about pediatric multiple sclerosis. Joining me is Dr. Charles Tyshkov. He's an assistant Professor of Clinical Pediatrics at Weill Cornell Medicine and an attending child neurologist at New York presbyterian Brooklyn Methodist Hospital.

Dr. Tyshkov, it's a pleasure to have you with us today. This is a really interesting topic and it's not something a lot of people know about. Can you speak a little bit because we think of MS as sort of a young adult 20s and 30s kind of thing. Can you tell us a little bit about the prevalence of MS in children?

Dr Charles Tyshkov: Sure. My pleasure to be here. So, multiple sclerosis in children is rare, but it's increasingly becoming more and more recognized. So just to give you some numbers, it's thought that up to 5,000 children and teenagers are living with MS in the United States today. And that's compared to up to a million adults with MS living in the US. But these numbers are constantly changing. And as people are becoming more and more aware of MS in children, the prevalence and incidence of pediatric MS continues to grow.

In general, pediatric MS tends to be a teenager type of onset, but we do occasionally even see younger and younger children presenting with signs of MS. But in general, most patients will present between 10 and 18 years or so. And those patients will present like adults in terms of their symptomology. It's the younger children who present in more atypical ways and that population really becomes difficult to figure out.

Melane Cole (Host): That's so interesting, doctor. So do we know the cause? Is there a genetic component? And you mentioned signs and symptoms and, for parents, please tell us what those look like.

Dr Charles Tyshkov: Sure. So the causes of MS are still very mysterious and unknown, but there are associations that we do know about. For example, the low vitamin D level in both children and adults. That's a well-known well-established association as a risk factor for MS. There are a few others, like a possible virus exposure, viral exposure in early childhood, which may prime the immune system to one day develop MS. And then there's the well-known climate, temperature, latitude association where classically MS is thought to be a disease of the Northern hemisphere. And what's interesting is we sometimes see pediatric cases of children who were born in more tropical climates, but then they moved to Northern climates and there's some thought that moving from a warmer climate to a colder climate in a particular time window might also put kids at risk.

There are known genetic associations, especially genes that are involved in vitamin D metabolism. And so increasingly, the vitamin D and genetic association has been explored and that continues to be a growing field of study.

Melane Cole (Host): And what about signs and symptoms? If children or teenagers start to exhibit, what is it that parents are looking for that would send them to their pediatrician in the first place?

Dr Charles Tyshkov: Signs and symptoms of MS in children and teenagers can be very much like signs and symptoms in adults. What people tend to think of as neurologic symptoms, so the symptoms include dizziness, vertigo, numbness, tingling in one part of the body, weakness in one part of the body, difficulty walking, what we call ataxia. And then there are brainstem symptoms that can sometimes affect the way the eyes move. So sometimes people will present with double or blurry vision. And then there are optic nerve issues, so that's the nerve behind the eye. And if that becomes inflamed, someone can experience vision loss, usually in one eye or changes in color perception.

So these are the classic symptoms. But again, in very young children, some of the presentations can be quite difficult to tease out because young children may not be able to fully express and communicate what they're experiencing. So I would say that the younger the patient, the more difficult it is to fully understand what's happening at the beginning and really requires quite a bit of time to work up the true cause of their symptoms.

Melane Cole (Host): So I'd like you to speak just briefly about diagnosis, but then really get into treatment. What's involved in managing children that present with multiple sclerosis? What types of therapies might be involved?

Dr Charles Tyshkov: The diagnosis in children really mirrors the diagnostic criteria that we use in adults. And so the diagnosis of MS relies upon specific criteria, which can be easily translated to the younger population. So the main things that we're looking for are evidence that there are lesions in space and time. So if there are symptoms that are spread out in time, for example, someone may recall having had an event or an episode one year ago, and then they present with a new episode that meets the criteria for something spread out in time. And space refers to different parts of the nervous system. So someone may have a lesion and symptom attached to that lesion in the brain and then another one in the spinal cord. And so once we are able to amass that type of evidence and definitely MRI becomes a really important piece of that puzzle. Sometimes we also do CSF, cerebral spinal fluid analysis, and that can also be very helpful in making the diagnosis. And so once we make that diagnosis, we can use many of the same disease-modifying therapy medications that are used in adults and apply them to children.

Disease-modifying therapy that we use in children can follow the same categories of medications that we use in adults. There are injectable medications. There are oral medications and infusion medications and really, depending on the specific needs of the patient and family, we can choose any one of those medications. But in general, children tend to do much better with oral medications and, for sometimes more severe cases, we go to the infusion medications. Children notoriously are afraid of needles, which is why some of the older injectable type of medications are not commonly used in children.

And so once we start a child on medication, again, depending on which one is used, that may mean that they need to do regular blood work and see some other specialists as well. But in general, these medications are very effective, if not more effective, in children because children in general tend to do so well in terms of recovery. So that's why it's so important to make the diagnosis early and start these children on medication so that they can recover quickly, bounce back to their regular selves and continue living their life as children.

Melane Cole (Host): Dr. Tyshkov, this is great information you're giving us, so comprehensive. You mentioned the word recovery. What does that mean in terms of children? Is this something that will follow them through life? Is this something that kind of waxes and wanes? You might see it in their teenage years, but then it might kind of relapse, remiss a little bit. Tell us a little bit about if this follows them and what they can expect as far as lifestyle?

Dr Charles Tyshkov: The majority of children and teenagers who are diagnosed with MS will be diagnosed with this relapsing-remitting subtype of MS, which means that they continue to be at risk for relapses. But the thinking is that if they're diagnosed early and started on a good medication, those relapses can be very well controlled.

Occasionally, there will be a relapse and sometimes that relapse is due to that medication not being given or being skipped, like a missed dose. Sometimes it can be due to the medication, just not being the right one and there are other options that we can switch to. But in general, children do very well on these medications and can experience many years of having no relapse, which is why it's very important to have that discussion with families and the children, that they can expect a normal life with that diagnosis. Many of our children grow up into very successful, productive adults. And it's very important to remind families that having a diagnosis of MS does not mean that these children will be permanently disabled.

It is true that children who are poorly controlled, they do accumulate disability over time. But that's why it's so important for these children to get established with a multiple sclerosis specialist who can work very closely with them and stay on top of all of their needs and issues to ensure that they have a good prognosis.

Melane Cole (Host): Excellent information. Thank you so much, doctor, for joining us today and sharing such an encouraging hopeful message for parents and so much education. Thank you again for joining us.

And Weill Cornell Medicine continues to see our patients in person, as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Kids Health Cast. We'd like to invite our audience to download, subscribe, rate, and review Kids Health Cast on Apple Podcast, Spotify and Google Podcast. For more health tips, please visit weillcornell.org and search podcasts. And don't forget to check out Back To Health.

I'm Melanie Cole.

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