For 5 percent of all individuals with multiple sclerosis (MS), onset occurs during childhood. Pediatric MS has the potential to impact not only a child’s normal daily life, but also their future physical, cognitive and mental health.
The Pediatric and Adult Multiple Sclerosis Program at Children’s Hospital of Philadelphia (CHOP) and the Hospital of the University of Pennsylvania is a unique program that offers age-span care for all individuals with MS. Our program provides comprehensive clinical care, expert nursing, pharmacy, psychiatry and psychology support, and occupational and physical therapy. We are recognized as a National Center of Excellence by the National Multiple Sclerosis Society (NMSS), we received funding from the NMSS and Transverse Myelitis Association for our MS and inflammatory CNS disease training program, and we are recipients of numerous grants to pursue our research priorities.
Focusing on why MS occurs
One of the most important research questions focuses on why MS occurs. Our research studies have demonstrated that vitamin D insufficiency is associated with a higher risk of MS in children, a finding that is also notable in adult-onset MS. The prevalence of MS is 1/800 people in regions such as Pennsylvania, where the amount of vitamin D synthesized in the skin is low in winter months. Vitamin D supplementation is an important part of MS care.
Our work and the work of others around the world also suggests that Epstein-Barr virus (EBV) may be a risk factor for MS. EBV is a common infection, with over 95 percent of adults being seropositive by age 30. However, what might be important is how an individual immune system “handles” EBV infection. EBV infection leads to long-lived EBV presence in B cells, with periodic reactivation of the virus and associated shedding of the virus in saliva (one of the reasons that this virus is so communicable).
We have shown that pediatric MS patients have increased viral shedding in saliva during approximately 60 percent to 70 percent of the year, compared to EBV-positive healthy youth, who shed EBV during only 20 percent of the year. We are now exploring specific immune responses to EBV to determine if EBV reactivation contributes to the overall dysregulated immune behavior that is a core facet of MS pathobiology.
Role of MRI in understanding MS
3T brain MRI ( flair) showing MS lesions
Our clinical and research programs also focus on MRI. Using advanced imaging techniques, we can now visualize the areas in the brain that are impacted by MS and we can measure the impact of the disease by quantifying brain volume.
In children, we have shown that MS leads to a reduction in age-expected maturational brain growth, as well as brain atrophy during adolescence. Brain atrophy is also a key finding in adults with MS.
These MRI studies are revealing important insights that will drive neuroprotective treatment strategies.
Women with MS Wellness Program
We are also now in the process of building a Women with MS Wellness Program. The program will be offered to all female MS patients from age 13 onward. Our focus will be:
- Understanding the health needs of women with MS
- Offering comprehensive medical services, including bone health services, pregnancy planning, pregnancy care, and postpartum MS management
- Considerations for women entering menopause
Since we know that many of the important symptoms of MS — such as fatigue, pain and depression — are improved by wellness activities such as exercise, healthy weight, nutrition, and emotional health support, we want to ensure that we address these important aspects as early as possible. We will work with our female MS patients to plan our program so that it is designed from the patient’s perspective. Wellness activities for men with MS will also be provided.
MS care and research at CHOP and Penn
MS is fundamentally a disorder of the immune system. We have recruited a world expert in MS neuroimmunology, Amit Bar-Or, MD, who will be joining the faculty in January 2017. His arrival will coincide with the creation of a truly world-class laboratory focusing on studies of the immune system in MS patients and other patients with disorders of the immune system and the brain. This novel program will not only help us understand MS, but will also allow us to evaluate why certain patients respond to different medications and how to best plan for individualized medical care.
This is an exciting time for MS care and research at CHOP and Penn. Our faculty are energized and committed to providing truly world-class care to patients of all ages. We welcome the opportunity to assess and provide care for children, youth and adults with MS and other inflammatory disorders.