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Interview with Dr. Brenda Banwell about MS in the pediatric population - part 2
Interview by Dr. Timothy Vartanian, Director of the Judith Jaffe Multiple Sclerosis Center, with Brenda Banwell, Director and Chief or Neurology at the Children’s Hospital in Philadelphia and the University of Pennsylvania.
There is a relationship between total T2 lesion volume and cognitive performance, we have not seen a robust regional influence, but the strongest relationship is the volume of the thalamus and overall brain volume, and cognitive performance. Pediatric MS patients have smaller than expected brain volume and show lower than expected brain growth, and in their teenage years show actual brain volume loss. Initial data, shown on a poster at AAN, indicated that the progression in young vs adult MS patients seems to be similar. More studies are needed in this field, and some technical hurdles to create well comparable measures between the two age groups still need to be taken. The concern is that white matter growth is not occurring as normal in young MS patients.
Pediatric MS is a relatively new field of study. First we replicated studies in adults to investigate if similar environmental stimuli are involved in MS development. Indeed, previous (remote) exposure to Epstein barr virus is seen in 80-85% of young MS patients, similar to the adult situation. There also is a correlation with lower vitamin D levels. Parental smoking may be a factor. CMV viral exposure shows a negative correlation with MS, and other common viruses show no correlation at all. It may however be important to what viruses you are exposed to, and in what order.
Dr. Banwell can not say much about the effects of ethnicity based on the Canadian data, but in US studies it has been shown that MS in the African-American population seems to be more aggressive.