Objective:

Background:

Multiple sclerosis is an immune-mediated demyelinating disorder of the central nervous system involving the brain, spinal cord, and optic nerves. Onset before age 18 is uncommon, and pediatric MS demonstrates distinct clinical and therapeutic characteristics compared to adult-onset MS. Disease-modifying therapies (DMTs) are not as extensively studied in children and presently there is only one FDA-approved pediatric DMT.

Design/Methods:

We performed a retrospective chart review of patients diagnosed with MS before age 18, between 2009 and 2024. Individual chart review included provider documentation, imaging and laboratory results, and medication histories. Data were compiled into a secure database and summarized descriptively by using standardized statistical metrics.

Results:

A total of 139 patients were identified (female = 96, male = 42). The mean age at diagnosis was 13.9 years (range 2–17, median 15). Among younger patients (ages 2–4), motor deficits and ataxia were the predominant presenting symptoms, whereas older patients (ages 11–17) more commonly presented with sensory or visual symptoms. Of patients receiving DMTs (n = 130, 93.5%), 49.2% remained on their initial regimen, while 33.8% required one switch and 16.9% underwent multiple regimen changes. Over time, DMT selection shifted from injectable to oral and intravenous agents. Patients started on newer, higher efficacy DMTs were less likely to relapse or discontinue due to side effects or adherence issues.

Conclusions:

Although MS is primarily an adult disease, it can present in children with age-dependent symptom patterns. Over the past two decades, our center’s treatment approach has evolved toward oral and intravenous DMTs, correlating with improved treatment stability and reduced switching frequency.