الفهرس 
Definitions and Epidemiology of Pediatric MSOnly 14 pages are availabe for public view
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Abstract
Multiple sclerosis (MS) is a chronic autoimmune illness of the central nervous system (CNS). It is the most common autoimmune disease in young adult with peak incidence between the ages of 20 and 40 years; however, It was found that 2.7-5% of all cases occur before the age of 18 years and called pediatric onset MS. pediatric onset MS was defined as multiple episodes of demyelination of the CNS separated by time and space as specified in adults started under the age of 18 years with no lower age limit. POMS involve children (< 12years) and adults (12-18 years). However, the cause of MS remains unknown. Pathogenesis involves immune mediated response targeting the CNS when genetically susceptible individual is exposed to environmental risk factor. Clinical manifestations of POMS are variable and may be detected by the location of lesions in the CNS and the main clinical course in pediatrics is RRMS which presents in more than 97% of cases. There are three major investigations used in patients with demyelinating symptoms which are MRI, Neurophysiological tests, Examination of CSF. Cranial MRI shows lesions in at least 95% of MS patients and plays a key role in diagnosis and follow-up. The goals of management of MS in children are to reduce the frequency and severity of relapses and slow the progression of the disease and manage the symptoms associated with MS in order to maintain quality of life (QoL) especially cognitive functions.
Our study was carried out on (20) patients, (4) males (20%) and (16) female (80%) with multiple sclerosis who had their first clinical symptom before the age of 18 and fulfilled IPMSSG diagnostic criteria for pediatric MS. We found a highly significant correlation between age of onset and the first clinical presentation with polyfocal presentation was more common in younger children and monofocal presentation was more common in adolescent. MRI brain distribution of lesion has a role in localizing the presenting symptoms with more children had infratentorial destribution in the follow up MRI explaining the predominance of brainstem attacks in pediatric population.
In conclusion, POMS has its clinical characteristic with most predominance of RRMS course and early polyfocal presentation which may be associated with encephalopathic features resembling ADEM presentation and MRI features that may be ADEM-like so the diagnostic assessment should include CSF analysis as well as evoked potentials. Awareness of pediatric MS symptoms and age dependent risk for MS might improve early diagnosis of MS in children and adolescents.