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Interview with Dr. Brenda Banwell about MS in the pediatric population - part 3
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.
Susceptibility genes in the pediatric population have been studied, especially looking at a higher genetic load that leads to earlier onset. Indeed the major MS allele was seen to be over-represented in these patients, but this was not really different from the adult patient group. Study of GWAS regions of MS susceptibility also revealed similar genetic involvement as adult MS patients. No genes stand out with regards to MS severity, but the pediatric patient population is also too small to reliably investigate this. Also, MS severity is difficult to measure in this population. rrMS biology seems to be pretty similar, if not identical, in the pediatric and adult populations. Primary progressive MS is as good as never seen in children. In rrMS the frequency of relapses seems to be a bit higher in children, and antibody titers to certain proteins may be a bit higher in the pediatric MS population, but this requires further research. Treatment first concerns involving the patient’s environment. Individual attacks are managed with corticosteroids, and with severe relapses this could switch to plasma exchange, as in adults. For controlling disease the interferon-family of drugs and glatiramer acetate are also the main drugs in kids. Clinical safety has been shown, although no clinical trials have been completed yet. This means most treatment in the pediatric population is off-label use of these drugs. As several options are now being put forward, it is difficult to study all in a rare disease as rrMS in the pediatric population. Also, immuno-modification in this population may have severely different effects / implications than in the adult population.