Preventing Multiple Sclerosis: The Pediatric Perspective

Duriel Hardy; Tanuja Chitnis; Emmanuelle Waubant; Brenda Banwell

doi:10.3389/fneur.2022.802380

Preventing Multiple Sclerosis: The Pediatric Perspective

Front Neurol. 2022 Feb 25:13:802380. doi: 10.3389/fneur.2022.802380. eCollection 2022.

Authors

Duriel Hardy^{1

2}, Tanuja Chitnis^{3

4}, Emmanuelle Waubant^{5

6}, Brenda Banwell^{7

8}

Affiliations

¹ Dell Children's Medical Center of Central Texas, Austin, TX, United States.
² Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, United States.
³ Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States.
⁴ Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
⁵ Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States.
⁶ San Francisco Multiple Sclerosis Center, University of California, San Francisco, San Francisco, CA, United States.
⁷ Center for Neuroinflammation and Neurotherapeutics, and Multiple Sclerosis Division, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
⁸ Division of Child Neurology, Department of Neurology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.

Abstract

Pediatric-onset multiple sclerosis (MS) is a predominantly relapsing-remitting neuroinflammatory disorder characterized by frequent relapses and high magnetic resonance imaging (MRI) lesion burden early in the disease course. Current treatment for pediatric MS relies on early initiation of disease-modifying therapies designed to prevent relapses and slow progression of disability. When considering the concept of MS prevention, one can conceptualize primary prevention (population- or at-risk population interventions that prevent the earliest facet of MS pathobiology and hence reduce disease incidence), or secondary prevention (prevention of disease consequence, such as reducing relapse frequency and lesion accrual, enhancing focal lesion repair, promoting CNS resilience against the more global facets of disease injury, and ultimately, preventing progression of neurological disability). Studying the pediatric MS population provides a unique opportunity to explore early-life exposures that contribute to the development of MS including perinatal and environmental risk determinants. Research is ongoing related to targeting these risk factors for potential MS primary prevention. Here we review these key risk factors, their proposed role in the pathogenesis of MS, and their potential implications for primary MS prevention.

Keywords: MS environmental risk factors; demyelinating disease; multiple sclerosis; pediatric multiple sclerosis (MS); preventative medicine.

Publication types

Review