Pediatric Multiple Sclerosis: Current Perspectives

Background: Pediatric onset multiple sclerosis accounts for up to 10% of all multiple sclerosis cases, and affects approximately 10,000 children in the United States with an additional 10,000 to 15,000 children demonstrating symptoms indicative of a pediatric onset multiple sclerosis diagnosis. Children with pediatric onset multiple sclerosis have higher relapse rates and reach irreversible disease status an average of 10 years earlier than adults with multiple sclerosis. Promotion of positive health behavior is one strategy for symptom management and potential disease modification in this group, as adults with multiple sclerosis have demonstrated similar benefits from interventions targeting health behaviors. 

Objectives: The present study seeks to describe and review current literature on health behavior for youth with pediatric onset multiple sclerosis, and inform future health-promoting interventions targeting these behaviors. For the purposes of this scoping review, health behaviors will be limited to topics of physical activity, diet, and sleep.

Methods: Papers related to health behavior participation in youth with pediatric onset multiple sclerosis were identified by searching three electronic databases. Studies were included in this review if they met the following criteria: (1) included pediatric onset multiple sclerosis as a primary population of interest; (2) referenced health behaviors of nutrition, diet, obesity, physical activity, exercise, or sleep; and (3) were published in English. 

Results: Literature regarding health behavior in pediatric onset multiple sclerosis is limited, but does suggest children with pediatric onset multiple sclerosis who participate in higher levels of certain health-promoting behaviors exhibit lessened disease burden. Children with pediatric onset multiple sclerosis consistently engage in less physical activity than controls. Physical activity participation reduces relapse rate, disease burden, and sleep/rest fatigue symptoms. Nutritional factors appear to be related to relapse rate. Children with pediatric onset multiple sclerosis have lower levels of iron than typically developing children, but no difference in other dietary factors. Obesity has direct link to risk of developing pediatric onset multiple sclerosis. Youth with pediatric onset multiple sclerosis engage in better routines related to sleep hygiene than healthy peers.

Conclusions: Children with pediatric onset multiple sclerosis may benefit from participation in health behaviors, particularly better physical activity, diet, and sleep. Although each of these health behaviors have evidence supporting the influential nature, there are no current interventions targeting promotion of these behaviors. Health behavior promotion in children with pediatric onset multiple sclerosis represents an appropriate method of managing primary and secondary symptoms.