A recent medical conference spotlighted a topic in multiple sclerosis that has received little attention. Doctors unveiled their findings on the treatment and diagnosis of MS in children.

According to the National Multiple Sclerosis Society, MS is relatively rare in children, though it affects an estimated 10,000 young people under the age of 18 who have definite MS. Another 15,000 children have symptoms suggestive of the illness.

While treatment protocols for children with the disease vary from clinic-to-clinic, medical experts in the field "are trying to reach a rational consensus regarding treatment," explained the study's lead investigator, Silvia Tenembaum, MD, of Hospital de Pediatria Dr. J.P. Garrahan in Buenos Aires, Argentina.

Drug Therapy in Pediatric MS Examined
One study on this topic released at the American Academy of Neurology (AAN) meeting in early April attempted to evaluate the safety of drug therapy in children.¹

Tenembaum and her colleagues reviewed the records of 43 children who had received one or more injections of Betaseron (interferon beta-1b) for an average of 30 months.

"While safety and tolerability of interferon beta-1b (250 micrograms every other day) in adults is well established, data on safety and tolerability of immunomodulatory treatments in children and adolescents are limited," wrote Tenembaum and her colleagues.

In their study, no serious adverse events were noted, but liver function tests came back abnormal in seven of 33 children with available information. This, however, is comparable to findings in adults who take the therapy, explained Tenembaum, in an interview with Priority Healthcare.

"In most cases, the elevation of liver enzymes is transient and asymptomatic," she said.

One child dropped out of the trial due to injection site pain.

Although this study didn't address the effectiveness of Betaseron, "physicians looking to treat MS in this population have at least some reassurance and data regarding the tolerability of interferon beta-1b," the investigators wrote.

Additionally, Tenebaum explained that she is about to present findings of a separate 6-year prospective study on the efficacy of Betaseron for pediatric MS at an upcoming meeting of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRMS 2005) in late September.

Safety of Other MS Therapies in Children
In a similar study released at the AAN meeting, the records of 51 children who had been treated with Rebif (interferon beta-1a) were reviewed to determine the medication's safety and tolerability in children.² Each child had been on therapy for an average of nearly 2 years. Most of the patients began receiving treatment at a dose of 22 micrograms (mcg) three times per week as an injection, which was increased to 44 mcg if the disease worsened. Two children experienced serious adverse events, but they resolved when therapy was halted, reported Daniela Pohl, MD, of Georg-August-University in Goettingen, Germany, and her associates. These included a general reaction that involved swelling, weakness, and fatigue. The second child experienced depression, the study authors reported. Other side effects, they wrote, were similar to those experienced by adults taking Rebif, such as influenza.

In terms of effectiveness, relapses decreased, on average, in the patients, and most saw their symptoms stabilize.

Nine patients withdrew from the study, six due to adverse effects, two due to needle phobia, and one because of the patient suspected the drug was not working. In conclusion, Pohl and her team maintained that Rebif was effective at reducing relapses and was generally well tolerated. "These promising results indicate that interferon beta-1a may be an effective approach in the treatment of childhood and juvenile MS," the investigators wrote.

Diagnosing Pediatric MS
Finally, a group of neurologists at the National Pediatric MS Center at the State University of New York released findings of a study on MS diagnosis. They found that identifying cognitive problems is crucial in children with the disease. To make that determination, William MacAllister, PhD, a neuropsychologist at SUNY and his colleagues administered neuropsychology tests to 37 children with MS. They found more than a third of them had cognitive disabilities.

They also noted that these cognitive abnormalities were closely linked with MS progression, such as the number of relapses and how long it had been since each child had been diagnosed.

In conclusion, MacAllister and his associates wrote, "This investigation provides the first evidence that progressive deterioration of cognitive function is possible in pediatric MS patients. Such dysfunction may lead to disruptions in academic functioning and future vocational function. It, therefore, must be assessed and monitored over time."

Identifying cognitive dysfunction in pediatric patients early is also imperative, they wrote, "to maximize the functioning of these children."

1. Tenembaum S, Banwell B, Boiko A et al. Treatment of childhood and adolescent multiple sclerosis with interferon beta-1b. American Academy of Neurology 57th Annual Meeting. 2005 9-16. Miami Beach, FL.
2. Pohl D, Rostasy K Hanefeld F. Multiple sclerosis in childhood and adolescence: treatment with subcutaneous interferon-beta-1a. American Academy of Neurology 57th Annual Meeting. 2005 9-16. Miami Beach, FL.

John Martin is a long-time health journalist and an editor for Priority Healthcare. His credits include overseeing health news coverage for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.