Abstract
Pediatric multiple sclerosis (MS) has long been an under-recognized MS subgroup. Fortunately, the special diagnostic challenges, the clinical course, treatment, and special needs of this MS subgroup are receiving increased attention. Pediatric MS occurs in most of the world although the frequency varies. Differential diagnoses such as the distinction from acute disseminated encephalomyelitis (ADEM) differ from adults. The pathogenic mechanisms remain unclear with respect to pediatric MS. The strongest association of pediatric MS is with remote EBV infection, possibly reflecting heightened immune activation or reactivation of EBV. Certain clinical aspects of pediatric MS overlap with adults but there are often differences particularly in the younger children in clinical, radiologic, and laboratory manifestations. Unfortunately, there is a sizable proportion of children and adolescents who are very vulnerable to cognitive dysfunction in addition to other psychosocial stresses. The family unit is critically important in this age group and plays a different role than in adult MS. Management is complicated by the lack of clinical trials specific to children. Nonetheless, experience in evaluating and treating children has rapidly grown. The current review summarizes this experience.