Paediatric multiple sclerosis is a demyelinating disorder with unpredictable relapsing and remitting periods. This can be confusing for patients and their families and cause a lot of stress. Earlier diagnosis and treatment could lead to better managed symptoms improving the quality of life of the patient. Exercise therapy is one intervention that is effective in managing symptoms. This article discusses the background of Paediatric multiple sclerosis, its symptoms, diagnosis, and treatment, focussing on exercise therapy as a therapeutic intervention to improve the management of symptoms.
What is paediatric multiple sclerosis?
In demyelinating disorders, the myelin sheath which is essentially a protective layer on the nerve cell, helps with faster signalling between nerve cell destructs. Multiple Sclerosis (MS) is one such disorder and is thought to be an autoimmune disease although the exact cause of MS is unknown. In rare cases, MS can be diagnosed in children. This is known as Paediatric Multiple Sclerosis.
Paediatric MS tends to be relapsing-remitting (RR). In this, the patient alternates between relapse and remission periods. During relapse periods, symptoms of MS exacerbate, and additional symptoms may also develop. Remission are period of stability. It is hard to predict when a relapse period may occur which could understandably lead to a lot of uncertainty for both the patients and their families.1
Symptoms
Patients may have symptoms including:
- Depression
- Memory loss
- Slower ability to process information
- Impaired vision
- Weakness
- Struggling to maintain balance
- Struggling to walk without assistance.
- And the most common symptom- fatigue.1
These symptoms may affect the patient’s ability to concentrate at school or work and may also mean days of school or work may have to be missed or stopped altogether. Not having a job would also have financial impacts which would result in poorer quality of life for the patient.1 Therefore, it is essential that individuals are diagnosed as early as possible so that symptoms may be managed with the appropriate therapeutic intervention.
Diagnosis
The main method used for diagnosis of MS is Magnetic Resonance Imaging (MRI). For children over the age of 12, two MRI scans are done at least a month apart. If gadolinium-enhancing legions or T2 legions are shown to be present in both scans, then the diagnosis can be confirmed. Children under the age of 12, can only be diagnosed after a minimum of two clinical events occur.1
Paediatric MS symptoms can look like symptoms of other disorders; therefore, doctors would have to first rule out all the other possible causes before MS can be diagnosed. For this reason, diagnosis is usually delayed in Paediatric MS which leads to a delay in treatment.2
Earlier diagnosis is key to better outcomes in patients which has resulted in a shift towards diagnosing through non-imaging-based techniques.2 Biomarkers usually present in MS patients are analysed as well as biomarkers of other conditions to make it easier to rule out the possibility of another disorder with similar symptoms to MS.
Common treatment methods
For paediatric multiple sclerosis, escalation therapy is the approach that is currently used. In this, treatment begins with the less effective treatment options due to them being safer and then using the more effective options following on from that if needed. A study recently has however proposed a new method where the more effective options are used first, so this may be the way treatment is done in the future2. Some of the disease-modifying therapies (DMTs) to help reduce relapse rates include fingolimod, rituximab, and natalizumab.1
Most of the medications are administered through injections which themselves can be stressful. A proposed method of dealing with this problem is by using more exercise therapy to help improve the quality of life of patients.
Exercise for paediatric multiple sclerosis patients
Exercise is an important part of a healthy lifestyle and around 150 minutes of exercise per week and strength exercises a minimum of 2 days a week are recommended for adults by the NHS. Exercise not only contributes to better physical health, but also has a positive effect on mental health and the overall wellbeing of an individual, and many studies show how exercise can help prevent neurodegeneration and improve overall brain function.3
There is an increasing amount of evidence showing that exercise may be used as a therapeutic intervention for MS patients to help reduce symptoms such as fatigue and help with balance.
Seven different exercise-based therapies are used to aid with treatment. These are aquatic exercise, pilates, yoga, resistance exercise, whole-body vibration exercise, aerobic exercise, and virtual reality exercise. Studies have found aquatic exercises to be particularly good at improving walking ability whilst yoga was found to be best for improving balance.4
Despite the research showing its benefits and healthcare providers working with patients to encourage exercise, the physical activity rate for MS patients has not increased by a lot over the last 30 years and the recent COVID-19 pandemic has made this worse. Patients need to follow the advice of healthcare providers for exercise. Neurologists would usually encourage patients to attend sessions with physiotherapists where they would be given recommended exercises based on their case and may even be provided with support from psychologists to aid with a positive mindset towards exercise. Other healthcare providers such as occupational therapists may also work together with the patient.3
Summary
Paediatric Multiple Sclerosis (MS) is a rare demyelinating autoimmune disorder in children, characterized by unpredictable relapsing and remitting periods. This condition leads to symptoms such as fatigue, impaired vision, weakness, balance issues, and cognitive challenges, which can significantly impact a child's daily life and academic performance. Early diagnosis is crucial, typically confirmed through MRI scans for those over 12 or after at least two clinical events for younger children.
Treatment often starts with less aggressive therapies, escalating if necessary, with disease-modifying therapies like fingolimod, rituximab, and natalizumab being common. Exercise therapy is increasingly recognized as an effective intervention to improve symptoms and overall quality of life. Various forms of exercise, including aquatic, yoga, and aerobic, have been shown to help with walking, balance, and fatigue. However, exercise participation remains low, exacerbated by recent pandemic conditions. Encouraging regular exercise, supported by healthcare providers, is vital for managing paediatric MS.
References
- Luca M, Ortega-Castro N, Patti F. Paediatric multiple sclerosis: a scoping review of patients’ and parents’ perspectives. Children. 2022;9(1): 11. https://doi.org/10.3390/children9010011.
- Duignan S, Brownlee W, Wassmer E, Hemingway C, Lim M, Ciccarelli O, et al. Paediatric multiple sclerosis: a new era in diagnosis and treatment. Developmental Medicine & Child Neurology. 2019;61(9): 1039–1049. https://doi.org/10.1111/dmcn.14212.
- Learmonth YC, Motl RW. Exercise training for multiple sclerosis: a narrative review of history, benefits, safety, guidelines, and promotion. International Journal of Environmental Research and Public Health. 2021;18(24): 13245. https://doi.org/10.3390/ijerph182413245.
- Hao Z, Zhang X, Chen P. Effects of different exercise therapies on balance function and functional walking ability in multiple sclerosis disease patients—a network meta-analysis of randomized controlled trials. International Journal of Environmental Research and Public Health. 2022;19(12): 7175. https://doi.org/10.3390/ijerph19127175.
