Paediatric onset inflammatory and neurodegenerative white matter disorders

Jutta Gärtner, Medical Director, Department for Paediatric and Adolescent Medicine, University Medical Centre, Göttingen

Multiple sclerosis (MS) is the most common neuroinflammatory disorder in the central nervous system. Paediatric MS with a clinical onset before the age of 18 occurs in about 3-10% of MS patients. The clinical course differs between paediatric and adult MS patients. The majority of paediatric MS patients has a relapsing-remitting course of disease. Children more often present with an acute disease onset associated with disabling clinical symptoms. They show a significantly higher relapse rate early in the disease, as well as high lesion loads on cerebral magnetic resonance imaging.  Remission after a severe relapse is much better in children than in adults. The exact aetiology of paediatric and adult MS is still unknown. Autoimmune, genetic and environmental factors play important roles in its onset and development. Neuroinflammatory demyelination and degeneration is the hallmark of adult and paediatric MS lesions, myelin repair seems to be better in younger patients. For paediatric MS the approach in differential diagnosis is particular complex since acute neuroinflammatory degeneration is not restricted to MS and other autoimmune disorders but is also present in monogenetic childhood onset neurodegenerative disorders such as cerebral X-linked adrenoleukodystrophy. Treatment for paediatric MS patients is mainly based on the approaches used for adult MS. Due to the rapid development of new highly effective monoclonal antibodies and oral medications for adult MS patients, treatment options for MS in children and adolescents have also expanded significantly