Pediatric multiple sclerosis in Venezuela Esclerosis múltiple pediátrica en Venezuela

Multiple sclerosis (MS) is a demyelinating disorder of the central nervous system and the most common disabling neurological disorder in young adults1,2. It is clinically characterized by a variety of neurological signs and symptoms which are attributed to white matter lesions. Those lesions are disseminated in time and space. Clinical signs may appear in sudden attacks or be insidious and progressive3,4. The diagnosis of pediatric MS has been largely overlooked by pediatricians and pediatric neurologists5,6, who have long regarded it as a rare disease. Recently, there is emerging evidence which proves that MS can manifest in childhood and adolescence. In addition, the challenges in its differential diagnosis make the diagnosis in this age group a difficult task7. Other disorders, including leukodystrophies and metabolic diseases, may masquerade the clinical picture of MS in pediatric patients. Furthermore, children with MS may present with clinical symptoms that can hardly be distinguished from acute disseminated encephalomyelitis (ADEM)5,8,9. Several reviews of the MS epidemiology reveal prevalence estimates of pediatric onset MS ranging from 2.7 to 10.5% of all people with MS5,10. However, most studies on pediatric MS come from high –risk areas and little is known about this disorder in Latin America11. Only three retrospective studies, two in Brazil12,13 and one in Venezuela14, have dealt with demographics and epidemiological characteristics of children with MS. In Venezuela, Peña et al.14 reported on the demographics