Pediatric demyelinating diseases: multiple sclerosis or not?

tral nervous system demyelination have been increasingly recognized in children. Moreover, a much higher proportion of children (as compared to adults) suffer from a monophasic (and not chronic) demyelinating event such as acute disseminated encephalomyelitis or isolated optic neuritis, and transverse myelitis, often post-infectious. Differentiation between such acute monophasic illnesses and a chronic demyelinating disease is extremely difficult and long clinical and neuroradiological follow-up is needed. Pediatric multiple sclerosis and neu-romyelitis optica have historically been diagnosed using adult criteria and treatment protocols. There is limited information and no controlled scientific data regarding the optimal diagnostic evaluation and treatment (both at the acute stage and in the long term) in pediatric central nervous system demyelinating diseases. Another important issue concerning chronic immunomodulating therapy in this age group is its unknown and possibly harmful effect on normal growth and development. Trying to deal with the above problems , European and American expert consortiums for pediatric Ms formulated consensus recommendations for the diagnosis and the suggested treatment protocols [1-3]. According to these recommendations , the diagnosis of pediatric Ms requires multiple episodes of CNs 2 demyelination separated in time and disseminated in space as accepted for adults [4], and there should be no lower age limit (e.g., including cases under the age of 10). CNS = central nervous system m ultiple sclerosis, like other autoim-mune diseases, starts at a young age with the majority of patients experiencing the initial symptoms between the ages of 20 and 40. However, in a not negligible proportion of patients the onset of Ms 1 occurs either at a much older age or during childhood. The pediatric Ms population deserves special consideration because of some unique features in this age group. Onset of a chronic disease like Ms at such an early age translates into a very long clinical course. Epidemiological data show that most of the pediatric Ms patients will remain disability free for longer periods from the time of onset as compared to adult patients. However, even if disability in these cases will appear 20–30 years after the initial symptoms, it will still occur at a young age, probably younger than in patients with adult Ms. Pediatric Ms needs special consideration not only because of the above epidemiological parameters, but also because many of the pediatric patients will be diagnosed later with another disease , not multiple sclerosis. Various additional clinical disorders (usually systemic autoimmune diseases …