Multiple Sclerosis Flares in Children: When to Go to Hospital

When Does an MS Flare Become an Emergency in a Child?

Understanding the warning signs of pediatric multiple sclerosis is important for recognizing when a flare becomes a medical emergency. Most of the MS flares that occur in a child are mild and do not require any treatment. However, if severe symptoms develop, then immediate medical attention is needed.

A pediatric MS flare becomes a medical emergency if the child presents with any one or more of the following symptoms:

• Sudden loss of vision.

• Severe pain that restricts one's functionality.

• The appearance of new symptoms accompanied by fever.

• Severe fever.

• Pain while urinating.

• Breathing difficulty.

• Loss of consciousness.

• Profound leg weakness and challenges with walking may be experienced in either one or both legs.

If the child experiences the above symptoms or other symptoms of a severe flare, immediate medical attention is required. In comparison with adults, MS flares in children show the following differences:

• Relapse frequency is higher in children when compared to adults with early MS. Studies show that relapse is two to three times more common in children, and this increased frequency persists for at least six years following disease onset.

• Relapses in children typically present with a polysymptomatic (more than one type of symptom) pattern, unlike adults.

• Children recover from relapse more quickly than adults. Adults may take six to eight weeks to recover compared to four weeks in children.

• Pediatric MS mainly presents as a relapsing-remitting type, while the progressive type is common in adults. In children, the frequency of progressive MS is less than seven percent.

Types of relapse according to symptoms include:

• Sensory relapse - Affects sensation.

• Cognitive relapse - Affects cognition.

• Mixed relapse - Affects two or more systems.

• Motor relapse - Weakness.

• Optic neuritis - Blurring of eye vision.

What Are the Triggers of MS Flares in Kids?

A few common triggers of MS flare-ups in a child are:

• Infection: Cold, flu, infections (Epstein-Barr virus), or urinary tract infections can weaken the immune system and contribute to MS flare-ups.

• Heat: Spending too much time outdoors (in sunny environments) can cause fatigue, further contributing to MS flare-ups.

• Fatigue: Fatigue due to overexertion can also contribute to MS flare-ups.

• Stress: Stress can hurt MS, worsening symptoms.

• Sleep deprivation: Sleep deprivation can also worsen the symptoms of MS.

• Others: Factors like low vitamin D levels, exposure to secondhand smoke, exposure to toxins (pesticides), childhood obesity, and genetic factors can also contribute to MS flares in kids.

How Are MS Flares in Children Treated?

Severe pediatric MS flares are treated with corticosteroids. Other treatment options are also used.

The treatment options for MS flares in children include the following:

1. Corticosteroids: Steroids can diminish inflammation and inhibit the immune system. Steroids can be taken orally or intravenously (IV). Methylprednisolone is commonly used for MS relapse treatment. Less frequently, Dexamethasone can also be used in place of IV Methylprednisolone.

Side effects of using steroids include the following:

• Insomnia (difficulty sleeping).

• Increased heart rate.

• Rashes.

• Metallic taste.

• Stomach upset.

• Acne.

• Flushing of the face.

• Fluid retention.

• Mood swings.

• Chest pain.

• Excessive sweating.

2. Plasma exchange: If an MS relapse presents with severe symptoms and the child does not respond to steroid treatment, plasma exchange is done in a hospital setting. This procedure is called plasmapheresis. The child's blood is taken from the body, and the blood cells and plasma are separated using a machine. Blood cells are transfused back into the body along with donor plasma. It helps clear pathogenic antibodies.

The side effects of plasma exchange include:

• Allergic reaction.

• Irregular heartbeat.

• Infection.

• Thrombocytopenia (decrease in platelets).

• Anemia.

• Hypotension.

• Bleeding.

• Hypoalbuminemia.

• Increased risk of thrombosis.

3. Rehabilitation: If MS flares severely affect the child's cognitive and physical abilities, then rehabilitation therapy is required, and it helps in the following ways:

• Physical therapy is used to manage balance, stiffness, spasms, etc. Physiotherapists provide home-based exercises to alleviate symptoms.

• Speech therapy is beneficial in cases where a child experiences difficulties with swallowing and speech.

• Occupational therapy to help the child cope with routine tasks at home and school.

• Cognitive therapy is used in cases where a child has behavioral problems or cognitive difficulties.

• Nursing care for bladder and bowel management.

4. Medications: If the child develops new symptoms during a relapse, the physician recommends medications to correct the symptoms. For example, medicines may be prescribed for the following conditions:

• Severe fatigue.

• Musculoskeletal pain.

• Nerve pain.

• Bladder problems.

• Bowel problems.

Medications include:

• Disease-modifying therapies: This is the primary treatment for pediatric multiple sclerosis. Disease-modifying therapies are helpful in relapsing-remitting MS. They prevent further relapses but have minimal effect on presently occurring relapses. They help reduce the severity and frequency of relapses. Fingolimod is a widely used oral medication among children.

• Immunosuppressive drugs: Immunosuppressive medications inhibit or suppress the immune system.

• Glatiramer acetate: Glatiramer acetate is an immunomodulator that blocks the immune system from attacking myelin.

• Beta interferon: Beta interferons belong to the immunomodulator group, which regulates the immune system and helps fight viral infection.

How Can MS Flares Be Prevented in Children?

There are several ways to help prevent MS flares in kids. These include,

• Following the proper treatment plan and taking proper medicines (disease-modifying therapies) as prescribed by the doctor. These medications are taken as an infusion or injection, which helps suppress the immune system. Starting medicines early after the diagnosis can reduce flares in children.

• Living a healthy lifestyle.

• Trying to stay calm and relaxed (doing things that make you feel happy).

• Going to bed on time helps your body rest and feel better.

• Choosing foods that help your body stay strong and healthy.

• Staying away from very hot or very cold places.

• Stay active, but don’t push yourself too hard.

• Figure out what makes your symptoms worse.

• Keeping your vaccines up to date.

• Visiting your doctor regularly.

Conclusion:

MS in children is almost exclusively diagnosed as a relapsing-remitting type. Progressive MS is rare in children, with an incidence of less than seven percent. On the other hand, in adults, progressive MS is more common.

So, relapses are more frequent in children than in adults. In most cases, these relapses are mild and do not require treatment. However, in cases where the child presents with severe flares, immediate medical attention is needed. In such cases, physicians usually start with steroid therapy, followed by plasma therapy and other disease modification therapies.

Key Takeaways:

• Kids can get MS too. Sometimes, they experience flare-ups, which means new symptoms start or old ones worsen.

• Most of the kids with MS have the most common form called the relapsing-remitting MS (98 percent). This means there are periods of new or worsening symptoms followed by partial or complete recovery.

Having MS as a kid can be hard, and parents need to be strong and supportive. However, with the help of an iCliniq pediatrician, families can learn how to manage MS more effectively and stay strong together.