MS was once thought of as just an adult disease, but, increasingly it is becoming more and more apparent that children and teenagers also are affected by this disease. To reflect this MSRC have created a seperate section devoted to this often overlooked community of people with Multiple Sclerosis.

Below you will find the latest breaking stories on Paediatric MS Research.

 MS In Children

A study published June 21 in the New England Journal of Medicine sheds new light on the course of multiple sclerosis in children. The findings include:

Summary
Executive Functions (EF) include a range of superordinate abilities that control performance across many tasks allowing for cognitive efficiency and mental flexibility.

Although EFs are commonly affected in MS, little is known about the EF components that are most affected, particularly in paediatric-onset MS patients.

Details
The objective of this work was to evaluate the components of executive function (EF) that are impaired in paediatric multiple sclerosis (MS), and determine the clinical and neural correlates of impaired EF.

Participants included 32 MS patients (26 females) and 20 controls (17 females) group-matched for sex and age, with a mean age at assessment of 16.2 ±2.1 years for patients and 15.5 ±1.9 years for controls.

EF components measured were attentional control / working memory, inhibition, cognitive flexibility, information processing, and behavioural manifestation of EF (as measured by parent-report on the BRIEF).

Multiple linear regression analyses were performed to assess the correlation of impaired EF components with clinical (age of disease onset, disease duration, and total number of relapses) and neuroimaging (T1- and T2- weighted total brain lesion volume (LV), and T2 frontal lobe LV) variables, adjusting for age, sex, and IQ.

Lesions were segmented using a fully automated, multi-spectral Bayesian technique, with manual correction where necessary.
Patients had a mean age of disease onset of 12.1 ± 3.7 years, average disease duration of 4.1  ± 3.2 years, and an average of 3.3  ± 2.1 relapses.

Relative to controls, MS patients had significantly lower IQ (t=-3.63, p<.01), and performed significantly poorer on measures of information processing and cognitive flexibility.

In MS patients, T2-weighted total brain and frontal lobe LV were significantly associated with all measures of EF, with adjusted r2 values ranging from 0.43 to 0.46 (p<.01 for all).

CONCLUSIONS / RELEVANCE: EF abilities are significantly reduced in paediatric MS patients compared with controls.

Reductions in EF correlate with total brain and frontal lobe LV, which highlights the impact of inflammatory activity on MS-related executive dysfunction.

Ameeta Dudani, North York, ON, Canada, Rezwan Ghassemi, Sridar Narayanan, Douglas Arnold, Montreal, QC, Canada, John Sled, Brenda Banwell, Christine Till, Toronto, ON, Canada AAN Toronto 2010 [IN2-1.003]

Supported by: The Canadian Institutes of Health Research (CIHR), The Multiple Sclerosis (MS) Society of Canada, and The Canadian MS Scientific Research Foundation.              

Source: The Multiple Sclerosis (MS) Society of Canada (30/07/10)

Abstract 
Cognitive impairment can be detected in a sizeable proportion of paediatric multiple sclerosis (MS) patients. It involves memory, complex attention, information processing speed, executive functions, linguistic abilities, and intelligent quotient. It has a great impact on school, everyday and social activities, and significantly progresses overtime in the great majority of the subjects.

These findings highlight the importance of a comprehensive and systematic assessment of MS-related cognitive difficulties in paediatric cases. Moreover, despite the acknowledged relevance of cognitive impairment in this age range, specific interventions for paediatric MS are lacking.

As for rehabilitative strategies, there is some evidence of efficacy in other diseases, in particular brain trauma, tumor, and stroke. The development of effective rehabilitative strategies tailored to the needs of young MS patients is a priority for future research in the field.

Emilio Portaccio¹ , Benedetta Goretti¹, Valentina Zipoli¹, Bahia Hakiki¹, Marta Giannini¹, Luisa Pastò¹, Lorenzo Razzolini¹ and Maria Pia Amato¹

⁽¹⁾ Department of Neurology, University of Florence, Viale Morgagni, 85, 50134 Florence, Italy

Source: SpringerLink Milan © Springer 2010 (22/07/10)

Abstract
Few studies report a protective role of childhood solar exposure to multiple sclerosis.

Our objective was to confirm the protective role of childhood solar exposure in multiple sclerosis in Cuba, Martinique and Sicily.

This was a matched case-control study, and cases met Poser criteria for clinically, laboratory (definite, probable) multiple sclerosis.

Controls were resident population, without neurological disorder, living close to cases (within 100 km), matched for sex, age (+/-5 years), residence before age 15. We recruited 551 subjects during a 1-year period (193 cases, Cuba n = 95, Sicily n = 50, Martinique n = 48; 358 controls). Some (89%) met definite clinical multiple sclerosis criteria (relapsing-remitting form (with and without sequel) (74%), secondary progressive (21%), primary progressive (5%)).

Odds ratios in a univariate analysis were: family history of multiple sclerosis (5.1) and autoimmune disorder (4.0); wearing shirt (3.5), hat (2.7), pants (2.4); sun exposure causing sunburn (1.8); sun exposure duration (1 h more/day; weekends 0.91, weekdays 0.86); bare-chested (0.6); water sports (0.2).

Independent factors in the multivariate analysis were family history of multiple sclerosis (4.8 (1.50-15.10)), wearing pants under sunlight (1.9 (1.10-3.20)), sun exposure duration (1 h more/day, weekdays 0.90 (0.85-0.98), weekends 0.93 (0.87-0.99)), water sports (0.23 (0.13-0.40)).

We conclude that outdoor leisure activities in addition to sun exposure reports are associated with a reduced multiple sclerosis risk, with evidence of dose response.

Dalmay F, Bhalla D, Nicoletti A, Cabrera-Gomez J, Cabre P, Ruiz F, Druet-Cabanac M, Dumas M, Preux P.

Université de Limoges, IFR 145 GEIST, Institut de Neurologie Tropicale; EA 3174 NeuroEpidémiologie Tropicale et Comparée, Faculté de Médecine, Limoges, France

Source: Pubmed PMID: 20463038 (19/05/10)

Abstract
In adult-onset multiple sclerosis (MS) cases, major depression, fatigue and psychological distress are common, whereas there is little information on these issues in children with the disease.

The aim of this study was to assess psychosocial disorders in an Italian cohort of children and adolescent with MS.

We evaluated 56 patients through self-assessment scales of depression (Children Depression Inventory) and fatigue (Fatigue Severity Scale), a psychiatric interview [Kiddie-SADS-Present and Lifetime Version (K-SADS-PL)] and an interview on school and everyday activities.

Significant fatigue was found in 11 patients (20%). Twelve of the 39 patients who underwent the K-SADS-PL received a formal diagnosis of an affective disorder. Moreover, MS affected school activities in 28% of cases, daily living activities in 41% and social relationships in 28%.

Our study confirms the critical role of psychosocial difficulties in children and adolescents with MS and provides a few cues to clinical management.

Goretti B, Ghezzi A, Portaccio E, Lori S, Zipoli V, Razzolini L, Moiola L, Falautano M, De Caro MF, Viterbo R, Patti F, Vecchio R, Pozzilli C, Bianchi V, Roscio M, Comi G, Trojano M, Amato MP.

Department of Neurology, University of Florence, Florence, Italy

Source: Pubmed PMID: 20454820 (19/05/10)

Abstract
OBJECTIVE: We sought to determine if vitamin D status, a risk factor for multiple sclerosis, is associated with the rate of subsequent clinical relapses in paediatric-onset multiple sclerosis.

METHODS: This is a retrospective study of patients with paediatric-onset multiple sclerosis or clinically isolated syndrome who were consecutively recruited into a prospective cohort at their clinical visit at the paediatric multiple sclerosis center of University of California, San Francisco or State University of New York at Stony Brook.

Of 171 eligible patients, 134 (78%) with multiple sclerosis/clinically isolated syndrome were included in the cohort; a further 24 were excluded from this analysis due to lack of available serum (n = 7) or lack of follow-up (n = 17). Serum 25-hydroxyvitamin D(3) levels were measured and were adjusted to reflect a deseasonalized value. The adjusted serum 25-hydroxyvitamin D(3) level was the primary predictor in a multivariate negative binomial regression model in which the main outcome measure was the number of subsequent relapses.

RESULTS: Among the 110 subjects, the mean unadjusted 25-hydroxyvitamin D(3) level was 22 +/- 9 ng/ml. After adjustment for age, gender, race, ethnicity, disease duration, disease-modifying therapy, and length of follow-up, every 10 ng/ml increase in the adjusted 25-hydroxyvitamin D(3) level was associated with a 34% decrease in the rate of subsequent relapses (incidence rate ratio, 0.66; 95% confidence interval, 0.46-0.95; p = 0.024).

INTERPRETATION: Lower serum 25-hydroxyvitamin D(3) levels are associated with a substantially increased subsequent relapse rate in paediatric-onset multiple sclerosis or clinically isolated syndrome, providing rationale for a randomized controlled trial of vitamin D supplementation.

Mowry EM, Krupp LB, Milazzo M, Chabas D, Strober JB, Belman AL, McDonald JC, Oksenberg JR, Bacchetti P, Waubant E.

MS Center, Department of Neurology, University of California, San Francisco, San Francisco, CA 94117, USA.

Source: Pubmed PMID: 20437559 (05/05/10)

BACKGROUND: Brain MRI is a useful tool for diagnosing inflammatory demyelinating disorders in children. However, it remains unclear which are the most reliable criteria for distinguishing multiple sclerosis (MS) from monophasic disorders such as acute disseminated encephalomyelitis (ADEM). We therefore compared the 4 current sets of MRI criteria in our Dutch paediatric cohort and determined which are the most useful in clinical practice for distinguishing ADEM from MS.

METHODS: We included 49 children who had had a demyelinating event and an MRI scan within 2 months of their first clinical attack. Twenty-one patients had ADEM and remained relapse-free after at least 2 years of follow-up. Twenty-eight patients had a definitive diagnosis of MS. We assessed the sensitivity and specificity of the following MRI criteria: Barkhof criteria, KIDMUS criteria, Callen MS-ADEM criteria, and Callen diagnostic MS criteria.

RESULTS: The Callen MS-ADEM criteria had the best combination of sensitivity (75%) and specificity (95%). The KIDMUS criteria had higher specificity (100%), but much lower sensitivity (11%). The Barkhof criteria had a sensitivity of 61% and a specificity of 91%. The Callen diagnostic MS criteria were the most sensitive (82%), but were only 52% specific for distinguishing a first attack of MS from ADEM.

CONCLUSIONS: The results in our cohort demonstrate that the new Callen criteria for multiple sclerosis-acute disseminated encephalomyelitis (MS-ADEM) are the most useful for differentiating a first attack of MS from monophasic ADEM. Although the Callen diagnostic MS criteria are more sensitive, they lack the specificity necessary to differentiate MS from ADEM.

Ketelslegers IA, Neuteboom RF, Boon M, Catsman-Berrevoets CE, Hintzen RQ; On behalf of the Dutch Pediatric MS Study Group.

From the Department of Neurology (I.A.K., R.F.N., R.Q.H.), Erasmus MC University Medical Center, Rotterdam; Department of Pediatric Neurology (M.B.), University Medical Center Groningen, Groningen; and Department of Pediatric Neurology (C.E.C.-B.), Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands.

Source: PubMed PMID: 20335562 (31/03/10)

Drinking milk during pregnancy reduces the chances of development of multiple sclerosis in children in their later life, says a new research study presented at the American Academy of Neurology’s annual meeting in Toronto, Canada.

The researchers from the Harvard School of Public Health in Boston, US found that children born to pregnant mothers who drank milk were at lower risk of having multiple sclerosis. This was similar in cases where the mothers took vitamin D during pregnancy as well.

Multiple sclerosis is a medical condition where the brain nerves are damaged and fails to communicate with the spinal cord. It may be seen relapsing in some cases and also show accumulation of the myelin sheaths over time. The common symptoms of this disease are weakness in muscles, spasms and difficulty in movement.

A study of 35,794 female nurses whose their mothers provided information about their diet pattern during pregnancy established the link between multiple sclerosis and pregnancy. Out of those nurses who took part in the study, 199 were found to develop multiple sclerosis after a span of 16 years.

The risk of multiple sclerosis was seen to be lower by 56 percent in daughters whose mothers drank milk (four glasses everyday) during pregnancy compared to those mothers who drank less than three glasses.

The mothers who consumed vitamin D during pregnancy gave birth to daughters with 45 percent lower risk than those whose vitamin D intake was less.

The findings of the study can help the mothers start having vitamin D and more milk during pregnancy to avoid their children suffer from multiple sclerosis when they grow up.

Source: Bolo Health © 2009 Bolohealth.com (10/02/10)

Low vitamin D blood levels are associated with a significantly higher risk of relapse attacks in patients with multiple sclerosis (MS) who develop the disease during childhood, according to a study conducted by researchers from the University of California, San Francisco.

“We have known for some time that vitamin D insufficiency is a risk factor for developing MS, but this is the first study to assess whether vitamin D levels influence the disease course of those who already have MS,” said lead author Ellen Mowry, MD, MCR, a clinical instructor of neurology at the UCSF Multiple Sclerosis Center.

The study, which is now published online by the “Annals of Neurology” and is available at http://www3.interscience.wiley.com/journal/123246501/abstract , demonstrates that an increase in vitamin D levels by 10 nanograms per milliliter of blood (ng/mL) corresponds with a 34 percent decrease in the rate of subsequent relapses.

In other words, raising the vitamin D level of a person with MS by 15 ng/mL, which requires about 2,000 international units of vitamin D supplementation a day, could theoretically cut a patient’s relapse rate in half, explained Mowry.

“Although we do not yet know if vitamin D supplementation will be beneficial for MS patients, the fact that there is a clear association between vitamin D levels and relapse rate provides strong rationale for conducting a clinical trial to measure the potential impact of supplementation,” she said.

“This is an exciting finding because it indicates that it is very possible for vitamin D supplementation to have a profound impact on the course of this disease,” said senior author Emmanuelle Waubant, MD, PhD, an associate professor of neurology at UCSF and director of the Regional Pediatric MS Center at UCSF Children’s Hospital. Waubant said she expects similar findings in adult patients with MS.

Multiple sclerosis is a chronic and often disabling disease that affects the central nervous system, which comprises the brain, spinal cord and optic nerves. A type of autoimmune disorder, MS causes the body’s own defense system to break down a substance called myelin, which surrounds and protects nerve fibers.

Although MS occurs most commonly in adults, a small proportion of cases are diagnosed in children and adolescents. According to the National MS Society, two to five percent of all people with MS experience their first symptoms before the age of 18.

The researchers measured vitamin D levels through blood samples from 110 patients whose MS symptoms began at age 18 or younger. The patients were seen at either UCSF Children’s Hospital or the State University of New York Stony Brook’s Regional Pediatric MS Center of Excellence – two of six multidisciplinary referral centers in the United States sponsored by the National MS Society.

After providing the initial blood sample, patients were followed for an average of 1.7 years, during which the researchers recorded the total number of relapses each patient experienced. According to Mowry, a relapse or flare-up of MS causes new neurologic symptoms or the worsening of old ones, such as impaired vision, problems with balance, or numbness. Relapses can be very mild or severe enough to interfere with a person’s ability to function.

During the follow-up period, the researchers assessed the patients’ relapse rates and vitamin D levels after controlling for such factors as age, gender, race, ethnicity, use of MS treatments and the duration of follow-up care.

“If we are able to confirm that vitamin D supplementation is an effective treatment, my hope is that it will help improve the quality of life for all MS patients,” Mowry said.

In addition to a randomized clinical trial of vitamin D supplementation in MS patients, Mowry said further studies are also needed to determine the mechanism by which vitamin D affects inflammatory processes and, in turn, eases symptoms of MS.

Additional co-authors from UCSF include Dorothee Chabas, MD, PhD; Jonathan Strober, MD; Jamie McDonald, BS; Jorge Oksenberg, PhD, and Peter Bacchetti, PhD. Co-authors from other institutions are Lauren Krupp, MD; Maria Milazzo, MS, CPNP, and Anita Belman, MD, all of the Pediatric MS Center, State University of New York at Stony Brook.

The study was supported by a National MS Society Sylvia Lawry Fellowship Award and an additional grant from the National MS Society.

Source: PRWEB (21/01/10)

Fatigue and quality of life are significant concerns in adult multiple sclerosis (MS) but little is known about these factors in paediatric MS.

The present investigation evaluates fatigue and quality of life in 51 paediatric MS patients to determine the rate of fatigue and reduced quality of life and assesses the relations between these variables and clinical factors.

Fatigue and quality of life were assessed by self- and parent-report via the PedsQL Multidimensional Fatigue Scale and the PedsQL Quality of Life Scale.

One-sample t-tests determined if scores were below published data for healthy individuals. Moreover, scores falling one standard deviation from norms were considered mildly affected, with severe difficulties being defined as scores falling two or more standard deviations from norms.

Associations between self- and parent-reported difficulties and clinical factors were examined via Pearson correlation analyses.

In comparison with healthy samples, paediatric MS patients reported greater difficulties with respect to fatigue, sleep, cognition, physical limitations, and academics. In addition to significant difficulties on these factors, parents reported problems with respect to emotional functioning, and tended to report greater fatigue, sleep, and cognitive difficulties than were self-reported.

Expanded Disability Status Scale score was the only neurologic variable significantly related to fatigue or quality of life scores. Fatigue was significantly correlated with reports of sleep difficulties, cognitive problems, and quality of life variables. These findings suggest that fatigue and poorer quality of life is a clear concern in paediatric MS, and is related to overall physical disability.

Magnetic resonance images (MRI) of patients diagnosed with multiple sclerosis in childhood show that pediatric onset multiple sclerosis is more aggressive, and causes more brain lesions, than MS diagnosed in adulthood, researchers at the University at Buffalo have reported.

Interestingly, however, patients with pediatric-onset MS -- which comprise up to 5 percent of total MS cases -- develop disabilities at a slower pace than patients with adult-onset MS, the data showed.

"Patients with pediatric-onset MS have three times as many relapses annually than patients with adult-onset disease, which suggests there is greater disease activity in this population," said Bianca Weinstock-Guttman, MD, associate professor of neurology in the UB School of Medicine and Biomedical Sciences and corresponding author.

"But surprisingly, the average time to reach the secondary progressive phase of the disease is longer in patients who develop MS in childhood than in adult onset MS," she continued. "Reaching the next stage of disability is almost 10 years longer in pediatric-onset patients."

Commenting on the study, Helen Yates, Multiple Sclerosis Resource Centre Chief Executive said, “This research is very interesting and has produced a somewhat unexpected result.  It has long been believed that relapse rate has a direct correlation to the increased rate of disability but this work suggests that this is not necessarily the case when it comes to MS diagnosed in childhood.  Obviously there needs to be more follow up research on this specific area to gain further insight into childhood MS”

Weinstock-Guttman directs the Pediatric Multiple Sclerosis Center of Excellence located at Women and Children's Hospital, and the William C. Baird MS Center in Buffalo General Hospital (BGH), both Kaleida Health affiliates and UB teaching hospitals.

Eluen A. Yeh, MD, UB assistant professor of neurology and co-director in the Pediatric Multiple Sclerosis Center, is first author on the study, which was published online Nov. 5 in Brain.

The National Multiple Sclerosis Society estimates that 8,000 to 10,000 children (defined as up to 18 years old) in the U.S. have multiple sclerosis, and another 10,000 to 15,000 have experienced at least one symptom suggestive of MS. The disease causes demyelination -- destruction of the sheath that protects and insulates nerve fibers. Breaks in the myelin sheath disrupt the flow of electrical impulses, causing loss of sensation and coordination.

The UB study involved four sets of patients:

• 17 children with an average age of 13.7 who were diagnosed with MS 2.7 years earlier

• 33 adults with an average age of 36.5 years who were diagnosed with pediatric MS 20 years earlier

• 81 adults with an average age of 40 who have had MS for an average of 2.6 years

• 300 adults with an average age of 50.5 who've had MS for 20 years

All participants underwent a brain MRI scan at facilities at BGH and at Women and Children's Hospital, while the specific MRI metric analysis was performed at the Buffalo Neuroimaging Analysis Center (BNAC), part of the UB Department of Neurology/Jacobs Neurological Institute, located in BGH. Robert Zivadinov, MD, PhD, UB associate professor of neurology, is director of the BNAC.

The MRI measured two types of brain tissue damage: T1-lesion volume, which shows "black holes," or hypointense lesions, which are areas of permanent axonal damage; and T2-lesion volume, which shows the total number of lesions (lesion load) and overall disease burden.

Both of these measures indicated that MS is more aggressive in children in the early stages, said Yeh.

"This corresponds with recent data that suggest a higher lesion burden in pediatric MS than adult-onset MS. These findings are somewhat surprising, considering we have assumed that children generally have a greater capacity for central nervous tissue repair."

"Our findings, which are limited to a cross-sectional study design, suggest that children have a somewhat better reserve and functional adaptability than adults, but less support for a better remyelination process," added Weinstock-Guttman. "However, the remyelination process may require a more in-depth prospective analysis"

Weinstock-Guttman said the data support the need for early diagnosis and therapeutic intervention in pediatric MS patients.

Murali Ramanathan, PhD, associate professor in the departments of Pharmaceutical Sciences and Neurology in the UB School of Pharmacy and Pharmaceutical Sciences and School of Medicine and Biomedical Sciences, respectively, also contributed significantly to the research. Additional contributors were Jennifer L. Cox, PhD, research assistant professor and BNAC's director of neuroimaging, and neurology research assistants Deepa Preeti Ramasamy and Laura M. Willis.

The research was supported in part by grants from the National Multiple Sclerosis Society and Children's Guild Foundation of Buffalo.

Source: Insciences Organisation Copyright Insciences Organisation 2009 and MSRC(17/11/09)

Objective:  To compare initial brain magnetic resonance imaging (MRI) characteristics of children and adults at multiple sclerosis (MS) onset.

Design:  Retrospective analysis of features of first brain MRI available at MS onset in patients with pediatric-onset and adult-onset MS.

Setting:  A pediatric and an adult MS center.

Patients:  Patients with pediatric-onset <18 years) and adult-onset (18 years) MS.

Main Outcome Measures:  We evaluated initial and second (when available) brain MRI scans obtained at the time of first MS symptoms for lesions that were T2-bright, ovoid and well defined, large (1cm), or enhancing.

Results:  We identified 41 patients with pediatric-onset MS and 35 patients with adult-onset MS. Children had a higher number of total T2- (median, 21 vs 6; P < .001) and large T2-bright areas (median, 4 vs 0; P < .001) than adults. Children more frequently had T2-bright foci in the posterior fossa (68.3% vs 31.4%; P = .001) and enhancing lesions (68.4% vs 21.2%; P < .001) than adults. On the second brain MRI, children had more new T2-bright (median, 2.5 vs 0; P < .001) and gadolinium-enhancing foci (P < .001) than adults. Except for corpus callosum involvement, race/ethnicity was not strongly associated with disease burden or lesion location on the first scan, although other associations cannot be excluded because of the width of the confidence intervals.

Conclusion:  While it is unknown whether the higher disease burden, posterior fossa involvement, and rate of new lesions in pediatric-onset MS are explained by age alone, these characteristics have been associated with worse disability progression in adults.

Authors: Emmanuelle Waubant, MD, PhD; Dorothee Chabas, MD, PhD; Darin T. Okuda, MD, MSc; Orit Glenn, MD; Ellen Mowry, MD; Roland G. Henry, PhD; Jonathan B. Strober, MD; Bruno Soares, MD; Max Wintermark, MD; Daniel Pelletier, MD

Author Affiliations: UCSF Regional Pediatric Multiple Sclerosis Center (Drs Waubant, Chabas, and Strober), UCSF Adult Multiple Sclerosis Center (Drs Okuda, Mowry, and Pelletier), and Department of Radiology, University of California, San Francisco (Drs Glenn, Henry, Soares, and Wintermark).

Source: Arch Neurol. 2009;66(8):967-971. (11/08/09)

Children who develop multiple sclerosis have substantially lower levels of vitamin D than children who do not develop the disease, according to a series of studies presented at an international conference on multiple sclerosis in Montreal.

Multiple sclerosis is a degenerative disease of the nervous system in which the myelin sheath that insulates nerve cells breaks down, leading to problems in the transmission of nervous signals. Symptoms can range from tingling and numbness to tremors, paralysis or blindness. An estimated 2.5 million people around the world suffer from the disease, which is rarely diagnosed before the age of 15.

In one study, researchers from the University of Toronto tested the vitamin D blood levels of 125 children who had exhibited symptoms indicating some form of damage to the myelin sheath.

"Three-quarters of our subjects were below the optimal levels for vitamin D," lead researcher Heather Hanwell said.

After a year, the researchers compared the data from the 20 children who had since been diagnosed with multiple sclerosis with those who had not exhibited any further demyelinating symptoms. They found that the average vitamin D levels of children who had been diagnosed with multiple sclerosis were substantially lower than those of the other children. Among the diagnosed children, 68 percent of children were actually deficient in the vitamin.

A similar study was conducted by researchers from Toronto's Hospital for Sick Children.

"Seventeen of 19 children who had been diagnosed with MS had vitamin D levels below the target level," researcher Brenda Banwell said.

Researchers have suspected a connection between vitamin D and multiple sclerosis for many years, ever since discovering that the disease is more common at more northern latitudes. Because the body synthesizes vitamin D upon exposure to sunlight, deficiency is much more common in places where the sun is weaker, especially during the winter.

"There is a very consistent pattern of latitude and multiple sclerosis," said epidemiologist and multiple sclerosis researcher Cedric Garland of the University of California-San Diego.

Hanwell directly linked Canada's northern latitude to its high rates of multiple sclerosis.

"In Canada for six months of the year the sun is not intense enough for us to manufacture vitamin D in our skin," she said.

Canada has one of the highest multiple sclerosis rates in the world. One of the few countries with a higher rate is Scotland, which has regions reached by only a quarter of all available sunlight. Recent research has confirmed a strong connection in Scotland between vitamin D deficiency and poor health status.

"People have been looking for things in the environment that might account for why Canada has such a high MS risk, and this is one of those factors," Banwell said.

It remains unclear exactly how vitamin D might influence multiple sclerosis risk, but researchers believe it may have to do with the immune system. New research continues to illuminate the role that vitamin D plays in the immune system, providing protection against cancer, tuberculosis and autoimmune diseases.

Many health researchers believe that multiple sclerosis is an autoimmune disease.

"Vitamin D acts as an immune modulator," Banwell said. "On our immune cells there are what are known as receptors, a docking mechanism, for vitamin D. In MS, there are many lines of evidence that immune cells are not regulated properly."

Researchers called vitamin D research one of the most promising areas of research into causes and potential cures for multiple sclerosis.

"The Canadian findings are very exciting and raise the possibility of targeting children at risk of MS and preventing some of the disease," said vitamin D researcher Oliver Gillie.

To prove that vitamin D is effective as a multiple sclerosis treatment or preventive - as well as to figure out what dose would be needed - researchers would first have to conduct large-scale clinical trials.

Source: Natural News.com © 2009 Natural News Network. All Rights Reserved (08/06/09)

A group of 12 proteins associated with pediatric multiple sclerosis (MS) have been discovered for the first time by a team of neurology and pathology researchers at Stony Brook University Medical Center. Led by Lauren Krupp, M.D., Director of the National Pediatric MS Center at SBUMC, the finding could lead to a new panel of diagnostic and prognostic markers in paediatric MS. Their study is reported in the April 2009 issue of the journal Multiple Sclerosis.

Multiple Sclerosis is an inflammatory autoimmune disease of the central nervous system (CNS) which usually affects young adults. It is the most disabling chronic disorder of this age group, affecting more than 400,000 in the United States. In some instances, children can be affected. Diagnosing MS in children and adolescents is difficult, and standard MS diagnostic tests such as cerebral spinal fluid (CSF) analysis and magnetic resonance imaging (MRI) are often unreliable.

“This is the first study of its kind in children with MS that has the potential to advance progress in the diagnosis and estimation of the prognosis of all individuals affected by this disease,” says Dr. Krupp, noting the potential of the method as an early disease-specific marker.

The Stony Brook team used specialized techniques for measuring multiple proteins at once (a method known as proteomics) in the blood of children with MS. They used plasma samples from nine children with MS and plasma from nine healthy children to complete the proteomic analysis. The researchers found differences in the amounts of multiple proteins in the blood of children with MS compared to those without disease. They found 12 proteins that differed in expression in the MS group. Some of the proteins had not been previously associated with disease.

“Proteomics is just being applied to the study of MS,” explains Dr. Krupp. “Because children develop MS so early with respect to potential environmental exposures, it is possible that determining the mechanism of action in MS of the identified proteins will elucidate further the pathogenesis of the disease.”

In “Protein expression profiles in pediatric multiple sclerosis: potential biomarkers,” the authors detail the proteomic analysis method. They used two-dimensional gel electrophoresis (2-DE) in combination with mass spectrometry to identify the proteins that were significantly expressed in pediatric MS group. This analysis was completed through the Proteomics Center at Stony Brook University.

The study was limited to children who met the international consensus definition of paediatric MS. All nine MS patients were girls age 14 to 17 years. They were matched to controls of healthy girls within the same age range.

According to the researchers, a larger number of subjects are needed to further validate their study findings. They believe their findings provide a significant basis for large studies to confirm and validate biomarker suitability in the blood. They will pursue such studies with the ultimate aim of identifying MS biomarkers that lead to the development of rapid, easy-to-use, widely available, and inexpensive MS diagnostic tests.

The Stony Brook pediatric MS proteomic research was supported, in part, with funding to Dr. Krupp from the Montel Williams MS Foundation and the National Multiple Sclerosis Society grant to the National Pediatric MS Center and National Center for Research Resources. Co-investigator Noy Rithidech, Ph.D., of the Department of Pathology, also received grants to complete the research from the Office of the Vice President for Research and the Office of Scientific Affairs at Stony Brook University, and NASA.

Source: Newswire Medical News © 2009 Newswise.(22/04/09)

The first major scientific study into multiple sclerosis in children in the UK has begun at Birmingham Children’s Hospital to attempt to understand the debilitating condition.

Researching doctors have been awarded a £400,000 grant by Action Medical Research and the MS Society, one of the largest it has ever given out.

The study will follow a group of children for five years to give more insight into how MS progresses from an early age, and increase understanding of the condition among doctors caring for children and young people.

Dr Doug Brown, biomedical research manager for the MS Society, said: “If we can pin down what happens very early on in MS, this will give us vital clues as to how the condition develops in adulthood.

“MS isn’t considered to be a childhood condition but we need to beat this misconception because it makes life tougher for those young people who live with it day in, day out.”

Current research into the number of children affected by MS is poor, but suggests that the onset of the condition occurs before the age of 16 in 0.4 to 10.5 per cent of cases, which could be anything up to 9,000 people in the UK.

Dr Evangeline Wassmer is leading the study in Birmingham with other centres in Oxford, Bristol, Nottingham and London taking part.

Source: Birmingham Mail.net  © 2009 Trinity Mirror Midlands Limited

An article published in the Spring 2009 edition of Multiple Sclerosis Quarterly Report, a joint publication of United Spinal Association and the North American Research Committee on Multiple Sclerosis (NARCOMS), reveals the importance of understanding the biological onset of Multiple Sclerosis in children as it can also lead to a greater understanding and treatment of MS in adults.

The article by Jean Marie B. Ahorro, MD and Brenda L. Banwell, MD of The Hospital for Sick Children in Toronto, Ontario Canada, highlights some of the latest information on paediatric MS, including risk factors, diagnosis, symptoms, and treatment strategies.

Presently, most care models for paediatric MS are based on protocols optimized in adults and pivotal studies of MS therapies are restricted to patients over 18 years of age. Conducting randomized control trials of paediatric MS has also been challenged by the rarity of the disease in children.

Brenda L Banwell, MD states, "By virtue of their young age, children are inherently closer to the biological onset of the MS disease process, and have a time-limited opportunity to have experienced irrelevant exposures. As such, research into MS triggers and understanding of the earliest aspects of immune dysregulation are particularly important in the paediatric MS population."

Banwell adds, "With respect to the International Paediatric MS initiative, I believe that the collective expertise will provide a strong rationale for prioritisation of trials of MS-medication in paediatric MS, and will be essential to achieve the patient numbers required for such trials."

The authors discuss the benefits of creating paediatric-specific MRI diagnostic criteria that are more sensitive and specific to children since the appearance of paediatric MS is not entirely similar to that of adult-onset.

Source: Market Watch © 2009 MarketWatch, Inc. (06/03/09)

Patients who develop multiple sclerosis before age 18 appear to experience more relapses of symptoms than those diagnosed with the disease as adults, according to a report in the January issue of Archives of Neurology.

"Although the clinical onset of multiple sclerosis (MS) typically occurs between ages 20 and 40 years, 2.7 percent to 10.5 percent of patients have been reported to develop their first symptoms before their 18th birthday," the authors write as background information in the article. Previous reports suggest the progression of MS—an inflammatory disease in which myelin, the protective coating covering nerve cells, degenerates—is slower in patients who are diagnosed in childhood.

Mark P. Gorman, M.D., of Brigham and Women's Hospital and Massachusetts General Hospital, Boston, and colleagues studied 110 patients diagnosed with relapsing-remitting MS in adulthood (average age at diagnosis, 34.4) and 21 with paediatric-onset MS (average age at diagnosis, 15.4). Relapsing-remitting is the most common type of MS, in which patients experience periods of symptoms followed by periods of symptom-free remission. Study participants developed their first symptoms in July 2001 or later, were monitored with semi-annual neurological examinations and were followed for 12 months or longer (an average of 3.67 years for paediatric-onset patients and 3.98 years for adult-onset).

Patients who developed the disease in childhood had, on average, a higher yearly rate of relapses than those who were diagnosed as adults (1.13 vs. 0.4 relapses per year). "These findings persisted in multivariate regression models when controlling for sex, race and proportion of disease spent undergoing disease-modifying treatment and when age at onset was treated as a continuous variable," the authors write.

"In general, the disease course of MS has been divided into a relapsing-remitting phase, during which inflammatory mechanisms predominate, and a secondary progressive phase, during which neurodegenerative mechanisms predominate," they continue. "Acute relapses are the clinical hallmark of the inflammatory phase of MS. The higher relapse rate in the paediatric-onset group in our study may therefore suggest that patients with paediatric-onset MS are coming to medical attention closer to the true biological onset of their disorder than patients with adult onset during a more inflammatory phase, as has been previously suggested."

If patients with paediatric-onset diseases do indeed have more relapses despite their disease progressing more slowly, "this discrepancy may suggest greater plasticity, less neurodegeneration and potentially more repair and remyelination in the younger nervous system. Further study of the biological basis for this discrepancy may yield insight into the apparent disconnect between relapses and long-term disability progression."

Source: JAMA and Archives Journals Arch Neurol. 2009;66[1]:54-59 (13/01/09)

Background  Natalizumab, a humanized monoclonal antibody raised against 4 integrins, is approved for treatment of active relapsing-remitting multiple sclerosis (RRMS) in adult patients.

Objective  To determine the safety, effectiveness, and tolerability of natalizumab use in pediatric patients with MS.

Design  Case report.

Setting  Center for MS in childhood and adolescents, Göttingen, Germany.

Patients  Three pediatric patients with RRMS having a poor response to other immunomodulatory therapies or having intolerable adverse effects.

Interventions  Natalizumab given every 4 weeks at a dosage of 3 to 5 mg/kg of body weight.

Main Outcome Measures  Cranial magnetic resonance (MR) imaging before treatment and every 6 months thereafter.

Results  During 24, 16, and 15 months of treatment, no further relapses occurred in the 3 pediatric patients; all reported significant improvement in their quality of life. Follow-up MR imaging showed no new T2-weighted lesions or gadolinium-enhancing lesions. No adverse events were seen when dosage was adjusted to body weight.

Conclusions  Natalizumab treatment was effective and well tolerated in our paediatric patients with RRMS who did not respond to initial immunomodulatory treatments. Therefore, it is a promising second-line therapy for paediatric patients with RRMS.

Peter Huppke, MD; Wiebke Stark, MD; Claudia Zürcher, MD; Brenda Huppke, MD; Wolfgang Brück, MD; Jutta Gärtner, MD

Author Affiliations: Departments of Pediatrics and Pediatric Neurology (Drs P. Huppke, Stark, Zürcher, B. Huppke, and Gärtner) and Neuropathology (Dr Brück), Faculty of Medicine, Georg August University, Göttingen, Germany.

Source: Arch Neurol. 2008;65(12):1655-1658. (09/12/08)

Canadian researchers say they have found new links between low levels of vitamin D in children and an increased risk that they may develop multiple sclerosis.

Speaking at an international meeting of MS specialists in Montreal, Dr. Brenda Banwell said that low levels of vitamin D in some children may explain why doctors are seeing more kids developing MS in Canada and other parts of the world.

"What we found is the children with the lowest vitamin D levels were far more likely to be diagnosed with multiple sclerosis than were children who had healthier levels of Vitamin D," she said.

Banwell and a team of scientists measured vitamin D levels from more than 100 children suffering what could be a first attack of MS.

Of those with the highest blood levels of the so-called "sunshine vitamin," only six percent went on to develop full-blown MS within the next two years. Twenty-seven percent developed MS among those with the lowest levels of the vitamin.

Multiple sclerosis is a chronic disease that attacks the central nervous system. Past studies have linked the disease, which affects about 55,000 Canadians, to environmental and genetic factors.

Researchers say low vitamin D levels are epidemic among children, and people without enough vitamin D are at risk for bone problems.

Doctors also believe that vitamin D may help keep the immune system functioning normally.

Researchers say too many Canadian children are not getting enough of the vitamin, which may be obtained naturally from sunshine.

"Children are indoors more they are on computers more, they play outdoors far less, but the consequence is, of course, they are getting little sunlight and little vitamin D," Banwell said.

Researchers are now trying to see if boosting vitamin D levels in kids with MS could help treat the disease and put it into remission. They're also trying to see if vitamin D can prevent the onset of the disease.

Source: Bernama.com © 2008 BERNAMA (21/09/08)

OBJECTIVE: To identify clinical, radiologic, or CSF factors that predict conversion to multiple sclerosis (MS) after a first attack of inflammatory demyelination in children.

METHODS: In this nationwide retrospective multicenter study in the Netherlands, 117 children below age 16 were included. Fifty-four children presented with a monofocal clinically isolated syndrome (CIS) and 63 children with a polyfocal CIS (PCIS).

RESULTS: A second MS-defining attack occurred in 43% of the CIS cases, compared to 21% of the patients with PCIS onset (p < 0.006). Basal ganglia and thalamic lesions and lesions larger than 2 cm on MRI (considered typical of ADEM) were observed during PCIS, irrespective of the presence of encephalopathy. No significant difference in developing MS was found in children with PCIS with or without encephalopathy. Elevated IgG index and presence of oligoclonal CSF bands were more often observed in children who developed MS. Both Barkhof and KIDMUS MRI criteria shared a high specificity and had a high positive predictive value for conversion to MS. In children under the age of 10, the Barkhof criteria had a higher sensitivity than the KIDMUS criteria, but still lower than in older children.

CONCLUSIONS: Barkhof and KIDMUS MRI criteria share a high specificity and positive prognostic value for conversion to multiple sclerosis (MS). Sensitivity of these criteria is poor, especially in children below 10 years of age. Basal ganglia lesions can occur in patients who later develop MS. A substantial number of patients presenting with polyfocal onset and no encephalopathy remained monophasic.

Source: PubMed PMID: 18672475 (13/08/08)

Multiple sclerosis in childhood and adolescence, a relatively rare form of the disease, is associated with impaired cognitive function and low IQ, say investigators.

More than half of a group of children and adolescents with MS had some degree of cognitive impairment, and almost a third had severe impairment, Maria Pia Amato, M.D., of the University of Florence, and colleagues in the MS Study Group of the Italian Neurological Society reported in the May 13 issue of Neurology.

Additionally, almost 10% of the young patients had a low IQ (<70), which appeared related to earlier age at onset of MS.

"We observed prominent defects of verbal and visuospatial memory, complex attention, and aspects of executive functions," the authors said. "Extrapolation of these findings would predict a high functional impact, because skills involving these faculties are increasingly emphasized in the higher academic degrees."

About 5% of MS cases occur in children and adolescents -- roughly 500 a year in the U.S. The disease's impact on cognitive function is hypothesized to be more dramatic in children than with adults with MS, the authors said.

Dr. Amato and colleagues reported findings from the largest study of the cognitive effects of MS in young patients, including 63 MS patients (mean age 15.8) and 57 age-matched healthy controls.

Both groups completed a battery of neuropsychologic tests that assessed IQ, memory, attention/concentration, executive functions, and language. The investigators also assessed fatigue and depression in the patients and the control group.

MS duration averaged three years, all patients had relapsing-remitting MS, and the mean disability score was 1.5. Forty patients had been treated with disease-modifying drugs, primarily interferon-beta. Duration of treatment averaged 1.3 years.

The patients' mean IQ was 101.3 versus 120.5 for the control group. Because the control group's score was in the superior range, investigators compared also compared the patients' scores with a subgroup of 40 controls, whose IQ averaged 106.2.

Two thirds of the patients versus 95% to 96% of the control group had IQ scores of 90 or higher. Seventeen patients (28%) had an IQ of 70 to 89, and five (8.6%) had an IQ <70 compared with two members (3.5%) of the controls. The only significant predictor of IQ <70 in the MS patients was earlier disease onset (P=0.009).

Nineteen patients (31%) met criteria for severe cognitive impairment (failure on three tests), and 32 (53%) failed at least two tests, the principal criterion for milder forms of cognitive impairment. The 19 patients with severe impairment had a mean IQ of 81.2, compared with 109.8 for the rest of the patients. Low IQ was the only correlate of cognitive impairment.

Three fourths of the patients met criteria for significant fatigue, pointing to a need to assess and treat fatigue in pediatric MS patients, the authors said. The patients had a depression prevalence of 6%.

Source: Medpage Today © 2004-2008 MedPage Today, LLC (13/05/08)

OBJECTIVE: We used voxel-based morphometry (VBM) to assess the pattern of regional grey matter (GM) loss in patients with paediatric multiple sclerosis (MS) and its relation with the Expanded Disability Status Scale (EDSS) score, disease duration, and the extent of T2 lesion load (LL).

METHODS: From 28 patients with paediatric relapsing-remitting MS (16 girls; mean age = 14.4 years, range = 7 to 16 years) and 21 matched controls, dual-echo and three-dimensional T1-weighted magnetization prepared rapid acquisition gradient echo sequences were acquired. T2 LL was measured using a local thresholding segmentation technique. Data were analyzed using an optimized VBM analysis and statistical parametric mapping.

RESULTS: In paediatric patients with MS, mean brain T2 LL was 7.8 mL +/- 11.3. Intracranial volume did not differ between patients and controls. Compared to controls, patients with paediatric MS had significant GM loss in the thalamus, bilaterally, which was significantly correlated with T2 LL (r = -0.80 for the right thalamus, r = -0.74 for the left thalamus, p < 0.05, corrected for multiple comparisons). No correlation was found between thalamic GM loss, disease duration, and disability.

CONCLUSIONS: In patients with paediatric multiple sclerosis (MS), differently from what happens in adult-onset MS, grey matter (GM) atrophy seems to involve the thalamus only, with sparing of the cortex and other deep GM nuclei. The correlation found between atrophy and T2 lesion load suggests transsynaptic and Wallerian degenerations as the most likely substrate of tissue loss in the thalamus of these patients.

Mesaros S, Rocca MA, Absinta M, Ghezzi A, Milani N, Moiola L, Veggiotti P, Comi G, Filippi M.

Neuroimaging Research Unit, Scientific Institute and University Hospital San Raffaele, Via Olgettina 60, 20132 Milan, Italy.

Source: Pubmed 18272867 (04/04/08)

"Information on sex, age of onset, clinical course, laboratory findings, and clinical characteristics of optic neuritis was obtained. The mean age at presentation was 7.31 +/- 2.99 years, and the mean duration of observation was 36.2 +/- 26.1 months. No female predilection (50%) was observed. The disease presented as relapsing-remitting type multiple sclerosis in all patients and transited to secondary progressive type in two cases (20%). No oligoclonal bands were found in any patient.

Optic neuritis occurred in eight patients (80%); five (62.5%) of these had optic neuritis at the first multiple sclerosis attack, with all five manifesting bilateral simultaneous optic neuritis. Visual acuity recovered to >= 20/40 in 8 of 15 eyes (53.3%), but in 2 eyes (13.3%) visual acuity remained at <= 20/200. In the patients with optic neuritis, the patients who showed optic neuritis at initial presentation had a worse visual prognosis (p = 0.030, Mann-Whitney, U-test). In Korean children with multiple sclerosis, age of onset was younger than reported in other countries, and there was no female predominance," wrote J.S. Hwang and colleagues, Seoul National University, Medical Department.

The researchers concluded: "The prognosis for good visual acuity was worse inpatients who initially presented with optic neuritis.'."

Hwang and colleagues published their study in the Journal of Aapos (Clinical characteristics of multiple sclerosis and associated optic neuritis in Korean children. Journal of Aapos, 2007;11(6):559-563).

Source: NewsRX © 2008 NewsRx (05/03/08)

Nationwide in the US, there are about 400,000 cases of multiple sclerosis. An increasing trend, however, is the diagnosis of this disease in children under the age of 18. It is now believed that one to five percent of all MS cases begin in children. Dr. Jayne Ness, associate professor of Pediatric Neurology at UAB, is determined to put a stop to this trend.

“My interest in this area of study is patient driven,” said Ness. “When I was a fellow in training, I was always trying to figure out what type of disease was affecting these kids. Throughout my training and beyond, I kept in touch with a lot of them and eventually put a project together. In the 1990’s, several therapies became available for adults who had multiple sclerosis; however, these were not applicable in children. We wanted to determine whether these treatments could be used safely in children with MS, but we also had to be careful to make sure the diagnosis of MS was correct since some children have diseases that mimic MS.”

MS is a disease in which a person’s immune system attacks the insulation surrounding nerve fibers in the brain and spinal cord. This material is composed of fats and proteins and, when damaged, prevents efficient conduction of electrical currents in the nervous system. This is a process much akin to a damaged wire on an electrical appliance such as a television, which causes a short circuit and, consequently, no “Desperate Housewives” tonight. As a result of the disease, people who have MS experience difficulty with movement, speech, balance and eyesight.

“He began to see with double vision and had very bad headaches,” said Brandon Enea of his now 15 year old son, Collin. “We took him to a local doctor, who gave us a real scare the first night. We were told that he did not have a tumor, but, other than that, no one could tell us what was wrong with him. The doctor suggested that we take him to the Children’s Hospital immediately, so we put Collin in the car and drove as fast as we could.”

On a regular basis, Ness sees patients from all over the southeast who have stories just like that of Collin. With funding from the National Multiple Sclerosis Society, Ness started the Center for Pediatric Onset Demyelinating Disease, where she and an entire team of doctors, nurses and researchers care for patients who are under the age of 21. CPODD is located in Children’s Hospital of Alabama and is one of only six Pediatric Multiple Sclerosis Centers of Excellence in the country.

“Because of the grant funding from the National Multiple Sclerosis Society, we have been able to do more organized studies of these kids,” said Ness. “By forming the CPODD team, we were trying to cover as many bases as possible; hopefully, this has also improved patient care.”

Indeed, patients and their families are satisfied with the level of care that they receive at the CPODD.

“The team here is amazing, everybody has been absolutely amazing,” said Rita Henry of her 17 year old daughter Leslie. “Leslie was 16 years old when she was diagnosed. Her first episode lasted two months and included numbness on the left side of her body, weakness, lost vision and slurred speech. No one could understand what she was saying. We have had to change everything about our daily life in order to get through that period. As a single parent, it has not been an easy process, but the CPODD team has helped tremendously.”

Leslie now leads a fairly typical teenage life, participating in numerous school and church activities such as the show choir, student council and the praise team; she is also a cheerleader at her high school. Moreover, in a matter of months, Leslie will be leaving home to attend Jackson State University, an accomplishment for people who have MS that was unheard-of in recent history.

“We know first-hand that people with MS can lead a normal life,” said Henry. “I think Leslie can be a spokesperson to help other kids who have been diagnosed with MS and encourage them to continue pursuing their dreams.”

Ness and her CPODD team plan to continue standing right beside patients and their families, supporting them every step of the way.

“We want to do everything we can to help people cope with this lifelong illness,” said Ness. “I believe that the future of MS is pretty bright. New therapies will soon arise that can be taken orally and eliminate the need for patients to receive injections. Ultimately, we hope to one day see a cure.”

Source: Kaleidoscope © 2008 The University of Alabama at Birmingham (27/02/08)

Debbie Andalo on the work being done to help them cope with a disease largely thought to affect only adults

Karen Pumpuni could be any ordinary teenager enjoying her half-term break. In her skinny jeans and T-shirt she crouches over her computer, breakfast on her lap, finishing off her AS-level English coursework. Only the wheelchair folded away in the corner of her home in Streatham, south London, gives a clue that her life is far less ordinary than that of other 16-year-olds. For the last two years Karen and her family have been coming to terms with her diagnosis of the neurological disease multiple sclerosis, which has only recently been acknowledged by the medical profession as a condition that affects children.

Karen is one of around five per cent of the 100,000 people in the UK with MS who are children. The chronic condition, traditionally associated with adults, affects the central nervous system creating symptoms of fatigue, loss of mobility and eyesight, and can result in long-term disability. It took doctors four years to diagnose Karen's condition, which came as a shock to her mother Eunice but also a relief.

She says: "I felt relief that Karen had been given a diagnosis. I had hoped that she would be diagnosed with something that would be instantly curable. At the same time I thought that the doctors might have made a mistake because I had never hard of children getting MS before and when I went home and looked on the internet there was nothing I could find out about it."

Karen was completely in the dark about the disease, which affects twice as many women as men. "I had heard about MS but I didn't know the symptoms like you would if it was cancer," she said. "I didn't know if it was something severe or something which could be easily treated like asthma." Two years on from her diagnosis she still feels isolated by the disease. She admits: "I feel like nobody understands what I go through."

This week the charity the MS Society is hoping that its first ever conference on childhood MS, held on Wednesday (November 7) in London, will go someway to help raise the public and health profession's understanding of the life that Karen and other young people like her face. The charity hopes that the conference will be the first step in the UK towards recognition of the condition in children, taking the lead from US and Canada.

The conference will aim to decide best practice for children with MS in the UK and look to where services need to be developed. At the moment the UK has only one dedicated centre for children with MS at the Birmingham children's hospital, and even there, no specialist MS nurses are trained to work with children.

Dr Evangeline Wassmer, the paediatric neurologist who heads the unit, says: "A lot of children with MS get seen by adult neurological services or get some shared care with paediatrics. It's a big issue – they are children and they need to be communicated with as children, it's not just a question of talking to their parents."

Dr Wassmer wants more dedicated MS children's centres and national prescribing guidelines changed so that the disease modifying drugs available for MS can routinely be given to children without prior approval of their primary care trust.

She is also keen to establish a longitudinal study of MS in children so that the disease can be tracked from a young age to adulthood. "At the moment we don't have that data, we don't know what happens to the disease if its onset is in childhood."

Dr Anita Rose is a specialist clinical psychologist for people with MS at the Walton centre of neurology and neurosurgery in Liverpool. While the centre is for adults with MS, she takes some child referrals and gives advice and support to health care professionals and families of young people with MS. She wants the UK to follow the US model and establish summer camps for children with MS as one way of breaking down their isolation. Social networking websites and YouTube could also be used, she suggests, to put young people in contact with each other.

She says: "It's a very isolating diagnosis. Children are very often scared, they get angry and depressed. They may know it's not a terminal condition, in fact the first question they ask is 'Am I going to die?' But they realise they may become disabled, that it's a life-long condition and they could be in a wheelchair by the age of 25."

This September the MS Society committed itself to dedicating "a year of youth", provisionally for 2009. This will highlight the issue of childhood MS, what it means for children and their families, as well as those young people who care for an adult parent with MS.

Details of the initiative are likely to be raised at Wednesday's conference, says Jayne Spink, the charity's director of policy and research. She says: "At the moment the charity doesn't provide anything for children or young adults with MS in terms of articles or information, because it's only recently that we have become aware of the whole issue."

She is hopeful that following the conference some of those gaps, and others, will be identified and filled. "We want to look at the best way of providing care and expertise. We want to find out what is being done for children, what we need to do and how we can bring that forward."

Source: Guardian Unlimited (05/11/07)

The onset of multiple sclerosis (MS) in childhood poses diagnostic and therapeutic challenges, particularly if the symptoms of the first demyelinating event resemble acute disseminated encephalomyelitis (ADEM). MRI is an invaluable diagnostic tool but it lacks the specificity to distinguish ADEM from the first attack of MS.

Advanced MRI techniques might have the required specificity to reveal whether the loss of integrity in non-lesional tissue occurs as a fundamental feature of MS. Although the onset of MS in childhood typically predicts a favourable short-term prognosis, some children are severely disabled, either physically or cognitively, and more than 50% are predicted to enter the secondary-progressive phase of the disease by the age of 30 years.

Immunomodulatory therapies for MS and their safe application in children can improve long-term prognosis. Genetic and environmental factors, such as viral infection, might be uniquely amenable to study in paediatric patients with MS. Understanding the immunological consequences of these putative exposures will shed light on the early pathological changes in MS.

Source: The Lancet Neurology (20/09/07)

BACKGROUND: The full spectrum of clinical manifestations and outcome, and the potential importance of regional or demographic features or viral triggers in paediatric multiple sclerosis (MS), has yet to be fully characterised. Our aim was to determine some of these characteristics in children with MS.

METHODS: 137 children with MS and 96 control participants matched by age and geographical region were recruited in a multinational study. They underwent structured clinical-demographic interviews, review of academic performance, physical examination, disability assessment (MS patients only), and standardised assays for IgG antibodies directed against Epstein-Barr virus, cytomegalovirus, parvovirus B19, varicella zoster virus, and herpes simplex virus.

FINDINGS: MS was relapsing-remitting at diagnosis in 136 (99%) children. The first MS attack resembled acute disseminated encephalomyelitis (ADEM) in 22 (16%) of the children, most under 10 years old (mean age 7.4 [SD 4.2] years). Children with ADEM-like presentations were significantly younger than were children with polyfocal (11.2 [4.5] years; p<0.0001) or monofocal (12.0 [3.8] years; p=0.0005) presentations. Permanent physical disability (EDSS>/=4.0) developed within 5 years in 15 (13%) of the 120 children for whom EDSS score was available. 23 (17%) had impaired academic performance, which was associated with increasing disease duration (p=0.02). Over 108 (86%) of the children with MS, irrespective of geographical residence, were seropositive for remote EBV infection, compared with only 61 (64%) of matched controls (p=0.025, adjusted for multiple comparisons). Children with MS did not differ from controls in seroprevalence of the other childhood viruses studied, nor with respect to month of birth, sibling number, sibling rank, or exposure to young siblings.

INTERPRETATION: Paediatric MS is a relapsing-remitting disease, with presenting features that vary by age at onset. MS in children might be associated with exposure to EBV, suggesting a possible role for EBV in MS pathobiology.

Banwell B, Krupp L, Kennedy J, Tellier R, Tenembaum S, Ness J, Belman A, Boiko A, Bykova O, Waubant E, Mah JK, Stoian C, Kremenchutzky M, Bardini MR, Ruggieri M, Rensel M, Hahn J, Weinstock-Guttman B, Yeh EA, Farrell K, Freedman M, Iivanainen M, Sevon M, Bhan V, Dilenge ME, Stephens D, Bar-Or A.

Division of Neurology, The Hospital for Sick Children, University of Toronto, ON, Canada; Research Institute, The Hospital for Sick Children, University of Toronto, ON, Canada.

Source: Lancet Neurol. 2007 (11/08/07)

People who spent more time in the sun as children may have a lower risk of developing multiple sclerosis (MS) than people who had less sun exposure during childhood, according to a study published in the July 24, 2007, issue of Neurology®.

For the study, researchers surveyed 79 pairs of identical twins with the same genetic risk for MS in which only one twin had MS. The twins were asked to specify whether they or their twin spent more time outdoors during hot days, cold days, and summer, and which one spent more time sun tanning, going to the beach and playing team sports as a child.

The study found the twin with MS spent less time in the sun as a child than the twin who did not have MS. Depending on the activity, the twin who spent more hours outdoors had a 25 to 57 percent reduced risk of developing MS. For example, the risk of developing MS was 49 percent lower for twins who spent more time sun tanning than their siblings.

“Sun exposure appears to have a protective effect against MS,” said study authors Talat Islam, MBBS, PhD, and Thomas Mack, MD, MPH, with the Keck School of Medicine of the University of Southern California in Los Angeles. “Exposure to ultra violet rays may induce protection against MS by alternative mechanisms, either directly by altering the cellular immune response or indirectly by producing immunoactive vitamin D.”

The study also found the protective effect of sun exposure was seen only among female twin pairs, but Mack says this novel finding must be viewed with caution since only a few male twins were involved in the study.

“Our findings note the importance of sun exposure among people with identical genetic risk for MS,” said Mack. “High priority should be given to research into how sun exposure reduces MS risk if we are to unravel the mystery of what causes MS.”

Source: American Academy of Neurology (24/07/07)

Background
The course and prognosis of childhood-onset multiple sclerosis have not been well described.

Methods
We used data from 13 adult neurology departments affiliated with the European Database for Multiple Sclerosis (EDMUS) network to identify a cohort of 394 patients who had multiple sclerosis with an onset at 16 years of age or younger and a comparison group of 1775 patients who had multiple sclerosis with an onset after 16 years of age. We determined the initial clinical features, the dates of disease onset, and the occurrence of outcomes, including relapse, conversion to secondary progression, and irreversible disability as measured by scores of 4 (limited walking ability but ability to walk more than 500 m without aid or rest), 6 (ability to walk with unilateral support no more than 100 m without rest), and 7 (ability to walk no more than 10 m without rest while using a wall or furniture for support) on the Kurtzke Disability Status Scale (range, 0 to 10; higher scores indicate more severe disability).

Results
For patients with childhood-onset multiple sclerosis, the estimated median time from onset to secondary progression was 28 years, and the median age at conversion to secondary progression was 41 years. The median times from onset to disability scores of 4, 6, and 7 were 20.0, 28.9, and 37.0 years, respectively, and the corresponding median ages were 34.6, 42.2, and 50.5 years. In comparison with patients with adult-onset disease, those with childhood-onset disease were more likely to be female than male (female:male ratio, 2.8 vs. 1.8), were more likely to have an exacerbating–remitting initial course (98% vs. 84%), took approximately 10 years longer to reach secondary progression and irreversible disability, and reached these landmarks at an age approximately 10 years younger (P<0.001 for all comparisons).

Conclusions
Patients with childhood-onset multiple sclerosis take longer to reach states of irreversible disability but do so at a younger age than patients with adult-onset multiple sclerosis.

Source Information
From Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon; INSERM Unité 842; and Université Lyon 1 — all in Lyon (C.R., S.V., C.C.); Hôpital de Bicêtre, Paris Kremlin-Bicêtre, Paris (Y.M., M.T.); Hôpital Pontchaillou, Rennes (G.E.); Hôpital Purpan, Toulouse (M.C.); Hôpital Saint Julien, Nancy (M.D.); Hôpital Pellegrin, Bordeaux (B.B.); Hôpital Pasteur, Nice (C.L.-F.); Hôpital de la Timone, Marseille (J.P.); Hôpital Général, Dijon (T.M.); Hôpital de la Pitié–Salpêtrière, Paris (C.L.); Hôpital Roger Salengro, Centre Hospitalier Régional Universitaire, Lille (P.V.); Hôpital Tenon, Paris (E.R.); and Centre Hospitalier Universitaire Dupuytren, Limoges (L.M.) — all in France; University Hospital Gasthuisberg, Leuven, Belgium (B.D.); and Royal Victoria Hospital, McGill University, Montreal (C.R., S.S.).

Source: The New England Journal of Medicine © 2007 Massachusetts Medical Society. (21/06/07)

Although multiple sclerosis is considered as an inflammatory demyelinating disease of young adults, nearly 3% of patients manifest it under the age of 16 years. The aim of this study was to highlight the clinical and demographic features of early-onset multiple sclerosis in Isfahan, Iran.

This prospective study concerned multiple sclerosis patients in whom the disease started before the age of 16 years and who were referred to the only clinic of multiple sclerosis in Isfahan. All early-onset multiple sclerosis patients underwent magnetic resonance imaging. Magnetic resonance imaging findings were analysed according to the Barkhof's criteria. All early-onset multiple sclerosis patients were followed for a mean period of 4.7 years.

Among 1,238 multiple sclerosis patients, 82 early-onset multiple sclerosis patients were identified. The female to male ratio was 4.5:1. The mean age of onset was 14.1 (range: 5 to 16) years. In 53 (65%) patients, the onset was monosymptomatic; in the remaining 29 (35%), it was polysymptomatic.

Source: Press TV © Press TV 2007. All rights reserved. (30/04/07)

Dr. Dorothee Chabas is a neurologist specialising in multiple sclerosis. The debilitating neurological condition identified by lesions on the brain. Every Tuesday, she's part of a multidisciplinary team at UCSF meeting with young patients and their families. A social worker, paediatric neurologist, neurologist and pediatric neuropyschologist, all listen together and offer input.

Twelve-year-old Samantha Richards found out last May her double vision and balance problems were actually symptoms of MS -- an MRI detected the lesions in her brain.

Samantha Richards, multiple sclerosis patient: "I am getting used to taking the medicines, it's just that it hurts, no matter what."

Multiple sclerosis affects about 400,000 people in this country(US). About 10,000 of them are children or teens. And about 10 to 15 percent of adults diagnosed with MS say they remember having initial symptoms before the age of 18.

Emmanuelle Waubant, MD, Ph.D.: "So what happens is either symptoms are mild enough that they are dismissed by the child or by the parents or by the physicians, or sometimes they're attributed to other diseases that are known to be more frequent in children."

Neurologist Emmanuelle Waubant is Director of UCSF's paediatric MS clinic -- the only one west of the Rockies.

Emmanuelle Waubant, MD, Ph.D.: "About 10 years ago, it was almost impossible to get a child with MS an authorisation to receive treatments that were authorised for adults."

But today, most insurance covers the treatment. And most doctors feel comfortable prescribing drugs like Interferon, which help slow the progression of the disease. The six paediatric MS centres across the country operate as a network -- sharing information, discussing difficult cases and collecting data.

Emmanuelle Waubant, MD, Ph.D.: "By building strong clinics, then we can develop very strong research as well."

Research that could help provide important clues to what causes MS.

Emmanuelle Waubant, MD, Ph.D.: "There is probably a set of environmental factors that contribute to the susceptibility of the disease and possibly to the course of the disease."

Dorothee Chabas, MD, Ph.D., Neurologist: "We are trying to collect information from the very beginning and follow them up over time and I think that's a really unique opportunity to do research on MS in general."

But one of the short term goals is simply getting the word out that multiple sclerosis exists in children -- letting community hospitals, paediatricians and internists know the signs.

Emmanuelle Waubant, MD, Ph.D.: "It can be decreased vision, it can be decreased balance, double vision, weakness in one limb or tingling or numbness in different parts of the body."

Mike Richards is just grateful his daughter's diagnosis came quickly and that the team of specialists is here for them at UCSF.

Mike Richards, Samantha's father: "They speak to you as a human being that's got feelings, and they're really concerned and want the best for Sam."

And together they decide on treatment options.

The Richards are taking things one day at a time, while praying for answers.

Mike Richards, Samantha's father: "Find out why it happens and find a cure for it so another child doesn't have to through it -- that would be the ultimate."

This team at UCSF hopes together, they can help do just that.

Source: ABC News Copyright ©2007 ABC Inc., KGO-TV San Francisco. (16/03/07)

Demyelinating diseases are disorders of the central nervous system, affecting the myelin sheaths that support nerve fibers. Multiple sclerosis is the most common form of such diseases.

Earlier this year, the National Multiple Sclerosis Society (NMSS) designated UAB’s pediatric-onset demyelinating disease clinic as one of six Paediatric Multiple Sclerosis Centers of Excellence in the country.

“The establishment of this center, coupled with the earlier NMSS recognition, places UAB at the forefront of efforts to better understand these diseases and the effects of early onset on disease progression,” said Jayne M. Ness, M.D., Ph.D., assistant professor of paediatric neurology and center director.

The center will provide state-of-the-art multi-disciplinary care and support for children, teens and families living with MS and other central nervous system demyelinating diseases.

C-PODD also will build a multi-ethnic research cohort of children and teens from around the country with demyelinating disease. In conjunction with the NMSS and other pediatric MS centers, center researchers will study this patient population with respect to clinical presentation, neuroimaging, laboratory findings, treatment regimens, neurocognitive functioning, quality-of-life measures and long-term functional outcome.

The center also will serve as a resource to provide up-to-date, accurate information about MS and related disorders to patients and families, schools, health care providers, funding agencies, third party payers, the scientific community and the public.

While MS is considered an adult disease, there are 8,000 to 10,000 children who have the ailment, and another 10,000 to 15,000 who have experienced what may be symptoms of MS, according to the NMSS. The disease is more difficult to diagnose in children, and many paediatricians are not familiar with MS. Even when diagnosed, consensus guidelines for treatment exist only in relationship to adult MS, with none for children, largely because there is little information about MS in children.

Source: UAB Media Center © 2005 University of Alabama at Birmingham (18/09/06)

At the paediatric MS center, patients and their families are able to see, in one sitting, clinicians who are paediatric specialists and MS specialists. “Children have historically been referred to an adult MS specialist, who may not know about the finer points of how the disease acts and how it is best treated in children,” says Emmanuelle Waubant, MD, PhD. “The families are left with a lot of questions and challenges.”

Patients coming to the paediatric MS center are evaluated and treated by a team that includes a paediatric neurologist and a nurse practitioner, adult MS specialists, a social worker and a neuropsychologist. “Parents say it’s a relief to be able to talk to all the specialists at once,” Waubant says. “Usually they shuttle from one to the next and often get conflicting or disconnected stories.”

Because of the subtle and varied nature of the disease, different members of the team may have different opinions about diagnosis or treatment even though they are seeing the same patient at the same time, Waubant says. The discussions that such perspectives produce can be good for patients, she says. “By having specialists interact directly with one another, they can benefit from each other’s views and provide the best possible care for the patients.”

Links:

USCF Regional Paediatric Multiple Sclerosis Center 

UCSF Regional Paediatric Multiple Sclerosis Center Fact Sheet (pdf) 

UCSF Awarded Grant for Paediatric Multiple Sclerosis Center - January 18, 2006

Source: The University of California, San Francisco Copyright 2006 (18/07/06) 

Among the 400,000 cases of MS diagnosed in the United States, 10,000 are paediatric cases, although neurologists think that there are probably many other cases being missed. “There may be up to 20,000 children with MS,” says UCSF researcher Emmanuelle Waubant, MD, PhD.

Even after diagnosis, children with MS and their parents are confronted by issues not faced by adult patients, Waubant says. After an MS diagnosis, children may be seen by adult neurologists who specialise in MS, but have little experience with children, or by paediatric neurologists who have little experience with the disorder, she says. The epidemiology and course of the disease are also different in children than in adults, and there may be a lack of information about the paediatric safety and efficacy of drugs used to treat adult MS. Such concerns have led to the creation of the newly opened UCSF Regional Paediatric MS Center

How Multiple Sclerosis Manifests in Children

Multiple sclerosis in children manifests itself differently than MS in adults, researchers say. In children, MS may begin after a first bout of neurological symptoms (called acute disseminated encephalomyelitis, or ADEM), which is felt to be temporary. “Most children with ADEM make a nice recovery and never have other symptoms, but a certain proportion continue to have symptoms and new symptoms occur later, thereby meeting the criteria of MS,” Waubant says.

The disease is thought to progress more slowly in children, but that is debatable when looking at an ethnically mixed population, Waubant says. The epidemiology of the disease also presents a different picture in adults and children. In adults, women get MS more often than men, but until puberty, MS afflicts boys and girls equally. And while the adult disease predominates among whites, in paediatric patients the pattern is the reverse, says Waubant, with far higher incidence and possible severity among minority children.

The cognitive consequences of MS are likely to be greater in children than in adults, possibly because children are still developing those skills and do not have sufficient cognitive capacity to fall back upon. “If children with MS are away from school for long periods, that only adds to the impact MS might have on their cognitive development,” Waubant says.

Paediatric MS Might Teach Us Much About MS in General

The study of paediatric MS offers the possibility of learning much more about the mysterious etiology of MS in general, researchers say. Multiple sclerosis has long been thought to have both genetic and environmental causes, but no specific environmental factor has been identified. In part, this is because the disease may strike long after exposure to such a factor. “Studying MS in children is offering a new window into studying environmental factors because the onset has to be much closer to the environmental exposure,” Waubant says.

Physicians treating children with MS face other complications. Because drugs for MS are tested in adults, physicians have often been hesitant to administer them without knowing that they are safe and efficacious in children. “This was also important because families’ health insurance plans would deny coverage for these drugs,” Waubant says.

Waubant led the first study of the safety of using interferon to treat MS in children. Since then, others have collected retrospective or prospective data to show that adult MS drugs are safe in children. Because of the nature of these studies, it will remain unclear how efficacious the drugs are in children.

Source: The University of California, San Francisco Copyright 2006 (18/07/06)

The Multiple Sclerosis Society of Canada announced findings from a Canadian study that shows the risk of MS may be influenced by place of residence during childhood rather than ancestry. The study results were published in a recent edition of Neuroepidemiology.

The study puts into question the belief that MS is a disease targeted primarily at Caucasians or those with ancestral ties to areas north of the equator such as Northern Europe.

The study involved 44 children and 573 adults from the paediatric MS clinic at the Hospital for Sick Children and the adult MS clinic at St. Michael's Hospital, both located in Toronto.

"By comparing study results with census data, we found that the MS population has become more multicultural as immigration to Ontario has increased," explains Dr. Brenda Banwell, director of the paediatric MS clinic at the Hospital for Sick Children and principal investigator for the study. "This adds great credence to our theory that childhood residence, more than ancestry, is a major determinant of MS risk."

The adult MS clinic population examined showed most of the patients, upwards of 90 percent, reported European heritage. Data from the 1971 census, obtained when most of the adult MS patients were growing up in Ontario, showed 84 percent of residents of Ontario were of European ancestry.

Meanwhile, paediatric MS patients were more likely to report Caribbean, Middle Eastern or Asian ancestry, accurately mirroring the population shift as detailed by the 2001 census.

"The common thread in all of this is that 100 percent of the paediatric population and 79 percent of the adult population grew up in Ontario," says Dr. Banwell. "This, combined with the ancestry data, suggests a prevailing influence of environment on MS risk."

According to the MS Society, this is an important study because the relative contributions of ancestry, country of birth and residence as determinants of MS risk have never been explored in the paediatric MS population.

"The change in immigration patterns, and the presence of well-established paediatric and adult MS programs, provided researchers with the unique opportunity to evaluate these factors as determinants of MS risk," says Dr. William J. McIlroy, national medical advisor for the MS Society of Canada. "The more complete a picture we can paint of MS and its risk factors, the closer we will be to finding the cause, and ultimately, the cure."

The study was funded by the MS Scientific Research Foundation which receives the majority of its funding from the MS Society of Canada.

Source: Multiple Sclerosis Society of Canada (24/05/06)

When the Paediatric Multiple Sclerosis Clinic opened at Toronto's Hospital for Sick Children in 1999, physicians expected five to 10 patients a year. Last year, they had 48.

Clinic director Dr. Brenda Banwell said each year at least 100 Canadian children are reported as having an initial attack (clinically isolated syndrome) and about 40 are diagnosed with the disease. But Dr. Banwell said she believes both these figures are under-representations.

While reports of children with MS symptoms date back to the 1920s, widespread recognition has only come in the last decade.

"I don't know if it's because MS is becoming that much more common or if it's because we are so much better at diagnosing it," she said. "I think it's a bit of 'if you build it, they will come' and now that paediatricians know what we do, we are seeing more kids. There is also more of the philosophy of getting an MRI right away."

But better diagnostic tools and increased awareness aside, Dr. Banwell believes there are simply more children with MS.

In April 2004, the Canadian Paediatric Society added MS to its Canadian Pediatric Surveillance Program, which sends every paediatrician in Canada monthly reminders of MS symptoms and asks them to report whether they saw cases.

The program acknowledged one of the barriers to diagnosis is lack of awareness of MS as a possible outcome of acute demyelination in children.

The possible outcomes of initial central nervous system demyelination include optic neuritis, transverse myelitis, hemisensory or hemi-motor syndromes, cerebellar or brainstem dysfunction or acute disseminated encephalomyelitis (ADEM).

Predicting whether symptoms represent an acute attack or are the beginning of MS remains a challenge. Many paediatricians don't view MS as possible in children, as it is widely viewed as an adult-onset disease.

When symptoms like weakness, tingling or impaired vision come and go, as they can in MS, Dr. Banwell says they're dismissed as viruses, stress or visual problems.

"Saying it was just a virus will mean these kids will not be closely followed. And some of them may be at risk for further attacks," she said, pointing out a doctor may not link a future attack to the first episode, which would point to MS.

But Dr. Banwell says because of the paediatric surveillance program and steps by the MS Society of Canada, paediatricians are quicker to look for MS.

Supporting the family

Dr. Brandon Meaney, head of neurology at McMaster Children's Hospital, agrees MS in children has been on paediatric neurologists' radar screens for some time, but some consciousness-raising has been needed in paediatricians.

"There is more discussion and awareness because of the surveillance program. Paediatricians and trainees are requesting information from me on ADEM and MS. Before we were pursuing it, now they're coming to us."

Dr. Meaney says about six kids a year in Hamilton are diagnosed with a demyelinating attack and one may go on to have MS.

Dr. Peter Nieman, a community paediatrician in Calgary, says that in 20 years in practice he has never diagnosed MS and doesn't think he's ever missed a case. But he is open to the possibility of MS in children.

"Things change. We used to say there's no way you get a stroke in kids, now we know that's not true," he said. "You have to be open to the possibility if it doesn't fit a particular diagnosis."

Because diseases like MS are more the domain of specialists, Dr. Nieman sees the paediatrician's role as supporting the family after diagnosis. "Families sometimes struggle with things like this. The paediatrician's focus can be helping the family with the psychosocial issues that follow it."

Dr. Marie-Emmanuelle Dilenge, a neurologist at Montreal Children's Hospital, said her department sees about two cases of MS a year and between five to 10 demyelinating episodes.

Montreal Children's is part of a five-year study at 22 Canadian hospitals following children who have had an initial attack. Researchers will determine if a particular combination of symptoms in a child with a first attack is more likely to lead to MS. They will look at the immune system of children with a first attack and at patterns of damage in the brain and spinal cord to determine if certain patterns predict who will go on to develop MS.

Dr. Dilenge said neurologists are seeing more diagnoses than expected and in children as young as six years old. "MS in children is still not well recognised by paediatricians or ophthalmologists, but I think it's coming," she said. "Doctors should be sure to think of a demyelinating event as a possibility and act on it faster with MRI."

Dr. Banwell agrees early diagnosis is key. "We should not dismiss episodic demyelination as being benign. It could be the beginning of MS," she said. "In a disease like MS, the earlier the treatment, the better. This includes counselling, physiotherapy and medical. So recognition is very important."

Source: The Medical Post © Copyright 2006 The Medical Post. All rights reserved.(11/04/06)

Dr. Brenda Banwell of the Hospital for Sick Children in Toronto studied 166 children: 63 with an autoimmune demyelinating syndrome -- either multiple sclerosis or an isolated event of central nervous system autoimmunity -- 43 with type I diabetes -- also an autoimmune disease -- 31 with a non-autoimmune neurological condition and 30 healthy controls.

They examined blood samples for T-cell proliferation in response to exposure to a variety of antigens, including myelin protein from nerve cells, proteins in the pancreas and proteins in milk.

About one-quarter of these children also showed a response to proinsulin, a T-cell target in type I diabetes. More than 60 percent also responded to a protein in milk. Ninety percent of the children with type 1 diabetes responded to pancreatic antigens as expected, but 79 percent responded to myelin and 90 percent responded to milk protein.

The responses seen against milk proteins raise the possibility that substances in food may be associated with autoimmunity, Barnwell told the American Academy of Neurology 58th annual meeting in San Diego.

Source: United Press International (08/04/06)

This is an older research article which I have just found, and thought it was very relevant to this page. Squiffs

TORONTO - Researchers at The Hospital for Sick Children (Sick Kids) have shown an association between paediatric multiple sclerosis (MS) and the Epstein-Barr virus (EBV), indicating that exposure to the virus at a certain time in childhood may be an important environmental trigger for the development of MS. This research is reported in the April 21, 2004 issue of JAMA (The Journal of the American Medical Association).

"Earlier studies suggested a relationship between childhood exposure to Epstein-Barr virus and the risk of developing MS. This is virtually impossible to quantify in adult MS patients, as nearly 90 per cent of the healthy adult population in Western countries has been exposed to EBV. In the paediatric patients, we can study viral exposures more easily, as children have fewer viral exposures due to their young age," said Dr. Brenda Banwell, the study's principal investigator, a Sick Kids neurologist and associate scientist, and an assistant professor in the Department of Paediatrics at the University of Toronto.

The research team found that 83 per cent of the paediatric MS patients showed evidence of a past EBV infection, compared with 42 per cent for the healthy control group. The paediatric MS patients also were less likely than the control subjects to have been exposed to herpes simplex virus. Epstein-Barr virus is very common and transmissible virus in the herpes family that causes infectious mononucleosis.

"We think the Epstein-Barr virus plays an important role in the development of MS, as the genetic code of the virus contains sequences that are identical to genetic sequences in the myelin basic protein, which is expressed in the brain, and destroyed in MS. It is conceivable that the immune system mounts a response to that genetic sequence in EBV, then sees it in myelin and targets it as well," added Dr. Banwell.

Multiple sclerosis (MS) is a disease of the brain, spinal cord, and optic nerves that can cause problems with muscle control and strength, vision, balance, sensation (such as numbness or tingling in your feet or hands), and mental functions such as thinking (cognition) and moods.

The symptoms of MS are caused by inflammation of the central nervous system and the destruction of myelin, the protein coating that surrounds and protects nerve fibres (axons).

MS is believed to involve a complex interplay between environmental triggers (such as infections), genetic predisposition, and an abnormal autoimmune response. At least five per cent of all MS patients experience the onset of their disease before the age of 18. It is estimated that 50,000 Canadians have MS. Multiple sclerosis is the most prevalent in countries that are furthest from the equator, such as Canada, northern Europe, and Australia.

"We suspect that it is the sequence and timing of viral exposure and how this modifies an individual's immune response that is important," said Dr. Banwell. "Children with MS are the closest to the biological onset of the disease, which allows us to look at a whole host of causative factors that are very difficult to study in adults."

Other members of the research team included Dr. Suad Alotaibi (now at the Al-Sabah Hospital in Kuwait), and Julia Kennedy, Dr. Raymond Tellier, and Derek Stephens, all from The Hospital for Sick Children.

This research was supported by The Hospital for Sick Children Foundation.

The Hospital for Sick Children, affiliated with the University of Toronto, is Canada's most research-intensive hospital and the largest centre dedicated to improving children's health in the country. Its mission is to provide the best in family-centred, compassionate care, to lead in scientific and clinical advancement, and to prepare the next generation of leaders in child health.

Source: Copyright © 1995-2006 ScienceDaily LLC

The Jacobs Neurological Institute of the University at Buffalo has received a $1.8 million, 5-year grant from the National Multiple Sclerosis Society to establish a paediatric multiple sclerosis center.

To be located at Women & Children's Hospital of Buffalo, it will be one of six such centers to be created in the United States.

The center will treat children under 18 years of age who have MS and other diseases of the central nervous system. The center also will function as a clinical and basic sciences research center on paediatric nervous system conditions and have an education mission to teach physicians and families about the symptoms and treatment options for children.

MS commonly is perceived as an "adult disease" that affects young to middle-aged adults. However, diagnostic tools now reveal that as many as 10,000 children -- or about 5 percent of all those diagnosed -- in the country have MS. About 15,000 children may have symptoms of MS.

Dr. Bianca Weinstock-Guttman,director of Jacobs' Baird MS Center and a UB associate professor of neurology, will be the director of the new center.

"Many general paediatricians are not familiar with MS, particularly since they are not expecting to see it in children," said Weinstock-Guttman. "The Paediatric MS Center will provide comprehensive care and a wide range of services, including in-patient and out-patient neurological care, physical therapy and rehabilitation and family education in the child-friendly environment of Women & Children's Hospital."

Western New York has one of highest rates of adult MS in the country, with approximately 160 diagnosed cases per 100,000 population, according to the Western New York/Northwestern Pennsylvania Chapter of the National Multiple Sclerosis Society. The national rate of diagnosed MS cases is approximately 50 per 100,000.

The other regional paediatric MS centers are in Long Island, San Francisco, Alabama, Minnesota and Massachusetts.

© 2006 American City Business Journals Inc (19/01/06)

MS Not Just An 'Adult Disease'; First-Of-Its-Kind Network of Paediatric Multiple Sclerosis Centers of Excellence Established Nationwide(USA).

Every hour in the United States, someone is diagnosed with multiple sclerosis, an unpredictable, often disabling disease of the central nervous system. While it's the most common neurological condition affecting young to middle-aged adults, emerging research suggests up to 10,000 children in the U.S. are living with the condition and another 15,000 have experienced MS-like symptoms such as double vision, numbness and unexplained fatigue.

The National Multiple Sclerosis Society is establishing this first-ever network of Paediatric MS Centers of Excellence as part of its new $30 million promise 2010 initiative supporting important yet under-explored areas of MS research and patient care.

Medical experts say one of the many challenges with paediatric MS is that it usually is not on a paediatrician's or a neurologist's radar screen when kids are reporting possible MS symptoms. These centers will give doctors the tools they need to help identify and treat MS early on.

Source: The National Multiple Sclerosis Society (28/12/05)

© Multiple Sclerosis Resource Centre