Andreea Badea

Background: Pediatric-onset multiple sclerosis (POMS) is a rare and heterogeneous condition, with clinical features, progression, and therapeutic response varying significantly according to age at onset. Early-onset MS (12 years) forms. Methods: We conducted a retrospective analysis of medical records from 120 pediatric patients diagnosed with MS at a tertiary neurology center between 2018 and 2024. Patients were grouped by age at onset and assessed for clinical presentation, number and timing of relapses, EDSS scores, imaging findings, and treatment patterns. Results: Early-onset MS was associated with atypical symptoms, delayed diagnosis, more frequent relapses, and multifocal brainstem and cerebellar involvement. The diagnosis was significantly delayed in younger children compared to adolescents. EDSS scores tended to remain stable in the first 2–3 years, but early-onset patients showed a notable decline after the fourth year. While most patients received disease-modifying therapies, high-efficacy agents were underused due to age-related restrictions. Intermediate-onset patients presented overlapping features of both early and late-onset MS and had the highest proportion of fully preserved motor function (EDSS 0) at the end of follow-up. MRI findings revealed more extensive and confluent lesions in younger patients, particularly in the first two years after onset. Conclusions: Age at disease onset is a key determinant of clinical course and treatment response in pediatric MS. Early recognition and timely initiation of appropriate therapy—especially high-efficacy agents—may improve outcomes and reduce long-term disability. Further multicenter studies with standardized imaging and cognitive assessment protocols are needed to optimize care for this vulnerable population.

Pediatric-onset multiple sclerosis (POMS) is a rare but increasingly recognized autoimmune condition affecting children under 18 years. The disease course is more aggressive than in adults, with frequent relapses, rapid accumulation of lesions, and early onset of motor and cognitive impairments. Due to limited approved disease-modifying therapies (DMTs) for children, first-line treatment often relies on injectable agents with moderate efficacy. Fingolimod, a high-efficacy therapy (HET), was recently approved for pediatric use, yet its uptake remains variable across regions. This retrospective, observational, monocentric study included 115 children diagnosed with POMS between 2018 and 2024 in a tertiary center in Romania. Patients were divided into three groups: 79 treated with interferon beta (IFNβ), 14 treated with fingolimod (FTY), and 22 untreated. We compared clinical outcomes, including annualized relapse rate (ARR), Expanded Disability Status Scale (EDSS) scores, and brain MRI lesion burden over 1 to 3 years of follow-up. Adverse events and treatment delays were also analyzed. All fingolimod-treated patients remained relapse-free during follow-up, while 42% of those on IFNβ experienced between 1 and 8 relapses. Fingolimod patients had significantly fewer new MRI lesions after 2 and 3 years of treatment (p < 0.01). EDSS scores remained stable or improved in both treated groups, with better outcomes in the FTY group. Adverse events included flu-like symptoms in all IFNβ-treated children and lymphopenia (mild to severe) in all FTY cases, managed by dose adjustment. Treatment initiation was delayed in the FTY group due to vaccination status and age-related barriers. Fingolimod demonstrated superior efficacy and comparable safety to IFNβ in pediatric MS. Our findings support early initiation of HETs in POMS and highlight real-world barriers to their implementation in Eastern Europe, including vaccination requirements and caregiver hesitancy.

This article examines the complex relationship between seizures, epilepsy, and multiple sclerosis (MS) in pediatric patients, based on detailed findings from a single-center study. Background: Although multiple sclerosis is primarily recognized as an adult-onset disease, its occurrence in children presents distinctive challenges, especially related to seizure disorders. Methods: We reviewed 120 pediatric MS patients evaluated over 7 years; six of these (5%) experienced seizures (including one case of acute status epilepticus), and five were diagnosed with epilepsy according to the latest International League Against Epilepsy (ILAE) classification. This study aimed to evaluate the occurrence rates and types of seizures while investigating their management strategies in this specific group. Results: Through a detailed case analysis and patient follow-up, we identified key factors contributing to seizure onset and explored implications for treatment and care. In our cohort, children with MS and seizures showed a higher risk for disease progression and greater cumulative disability, evidenced by a significantly higher last Expanded Disability Status Scale (EDSS) score (after a minimum 2-year follow-up) in the seizure group (p < 0.006). The analysis recognized early MS onset and highly active disease types as further risk factors that led to worse health outcomes. Conclusions: Genetic causes of epilepsy in children are common and may interact with MS-related inflammation in the same patient; our observations underscore the need to investigate how these two conditions interact. This work contributes to the broader understanding of epilepsy comorbid with MS among pediatric patients, seeking to facilitate the creation of improved interdisciplinary clinical practices in pediatric neurology.

This article examines the complex relationship between seizures, epilepsy, and multiple sclerosis (MS) in pediatric patients, based on detailed findings from a single-center study. Background : Although multiple sclerosis is primarily recognized as an adult-onset disease, its occurrence in children presents distinctive challenges, especially related to seizure disorders. Methods : We reviewed 120 pediatric MS patients evaluated over 7 years; 6 of these (5%) experienced seizures (including one case of acute status epilepticus), and 5 were diagnosed with epilepsy according to the latest ILAE classification. This study aims to evaluate the occurrence rates and types of seizures while investigating their management strategies in this specific group. Results: Through detailed case analysis and patient follow-up, we identified key factors contributing to seizure onset and explored implications for treatment and care. In our cohort, children with MS and seizures showed a higher risk for disease progression and greater cumulative disability, evidenced by a significantly higher last Expanded Disability Status Scale (EDSS) score (after a minimum 2-year follow-up) in the seizure group (p < 0.006). The analysis recognized early MS onset and highly active disease types as further risk factors that led to worse health outcomes. Conclusions: Genetic causes of epilepsy in children are common and may interplay with MS-related inflammation in the same patient; our observations underscore the need to investigate how these two conditions interact. This work contributes to the broader understanding of epilepsy comorbidity with MS among pediatric patients, to facilitate the creation of improved interdisciplinary clinical practices in pediatric neurology.