title: Multiple sclerosis in children: an update on clinical diagnosis, therapeutic strategies, and research.
abstract: The clinical features, diagnostic challenges, neuroimaging appearance, therapeutic options, and pathobiological research progress in childhood-and adolescent-onset multiple sclerosis have been informed by many new insights in the past 7 years. National programmes in several countries, collaborative research efforts, and an established international paediatric multiple sclerosis study group have contributed to revised clinical diagnostic definitions, identified clinical features of multiple sclerosis that differ by age of onset, and made recommendations regarding the treatment of paediatric multiple sclerosis. The relative risks conveyed by genetic and environmental factors to paediatric multiple sclerosis have been the subject of several large cohort studies. MRI features have been characterised in terms of qualitative descriptions of lesion distribution and applicability of MRI aspects to multiple sclerosis diagnostic criteria, and quantitative studies have assessed total lesion burden and the effect of the disease on global and regional brain volume. Humoral-based and cell-based assays have identified antibodies against myelin, potassium-channel proteins, and T-cell profiles that support an adult-like T-cell repertoire and cellular reactivity against myelin in paediatric patients with multiple sclerosis. Finally, the safety and efficacy of standard first-line therapies in paediatric multiple sclerosis populations are now appreciated in more detail, and consensus views on the future conduct and feasibility of phase 3 trials for new drugs have been proposed.
authors.affiliation: Division of Neurology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Waldman
authors.affiliation: Ospedale di Gallarate, Centro Studi Sclerosi Multipla, Gallarate, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Ghezzi
authors.affiliation: Montreal Neurological Institute, McGill University, Montreal, QC, Canada.
authors.forename: Amit
authors.initials: A
authors.lastname: Bar-Or
authors.affiliation: Unité de Rééducation Neurologique Infantile, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Yann
authors.initials: Y
authors.lastname: Mikaeloff
authors.affiliation: Service de Neurologie Pédiatrique, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Tardieu
authors.affiliation: Division of Neurology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: banwellb@email.chop.edu.
authors.forename: Brenda
authors.initials: B
authors.lastname: Banwell
mesh_terms: D000293:Adolescent; D002648:Child; D006801:Humans; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology / Q000628:therapy