Why is it more difficult to diagnose MS in children than in adults?

Pediatric multiple sclerosis (MS) can be difficult to diagnose. Young children may not tell their parents or doctors about all of their symptoms. Also, while pediatricians and neurologists are becoming more aware of pediatric MS, there are still relatively few doctors who specialize in treating MS in kids. As a result, many children and teens first see their pediatrician or a general neurologist, who may not be familiar with pediatric MS.

Even doctors who are well­versed in MS can have problems narrowing down the diagnosis in children. This is, in part, because vision problems and some other first symptoms are not unique to MS. At first, other neurological conditions, including acute disseminated encephalomyelitis (ADEM), may seem like a more likely diagnosis. ADEM is far more common than MS in children, for example. It can sometimes happen after a vaccination or illness. Despite certain similarities, children with ADEM have symptoms that are rarely or never seen with MS, such as fever, sleepiness, nausea and vomiting, and their condition usually gets better on its own.

Complicating matters even more is the fact that the standards for diagnosing MS don’t always translate well to children. When it comes to magnetic resonance imaging (MRI), which looks for scarring from MS on the brain and spinal cord, as few as one-third of all children with MS meet the diagnostic criteria. Especially in young children, an MRI often shows fewer lesions than would be seen in an adult with MS. Or, the lesions may look different in children. Because of this, there is a push for MRI diagnostic criteria that are specific to children with MS.

To make a clear MS diagnosis in a child, a doctor or medical team will look at their symptoms and medical history, as well as their reflexes and coordination. Lab tests, most specifically lumbar puncture (also known as a spinal tap) also play a significant role. Oligoclonal bands (also called OCBs) are found in the spinal fluid of more than 90% of children with MS.

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