Abstract
•Experts in Saudi Arabia recommend the use of the international paediatric multiple sclerosis study group guidelines for the diagnosis of multiple sclerosis in paediatric patients.•Gadolinium-enhanced central nervous system MRI, cerebrospinal fluid studies, infectious agents screening and auto-antibodies workup are the mainstay of diagnosis.•The suggested initial therapy is interferon beta at 25–50% of the adult dose with gradual titration to the full adult dose as tolerated.•The management of relapse involves high-dose intravenous steroid pulse therapy (e.g., 10–30 mg/day of Methylprednisolone) for 3–5 days.•Intravenous immunoglobulin infusion at a dose of 2 g/kg administered over 2–5 days should be considered for steroid-unresponsive acute disseminated encephalomyelitis.
Multiple sclerosis (MS) most commonly presents in young adults, although 3–5% of patients develop MS prior to the age of 18 years. The new and comprehensive consensus for the management of MS in Saudi Arabia includes recommendations for the management of MS and other CNS inflammatory demyelinating disorders in pediatric and adolescent patients. This article summarizes the key recommendations for the diagnosis and management of these disorders in young patients. Pediatric and adult populations with MS differ in their presentation and clinical course. Careful differential diagnosis is important to exclude alternative diagnoses such as acute disseminated encephalomyelitis (ADEM) or neuromyelitis optica spectrum disorders (NMOSD). The diagnosis of MS in a pediatric/adolescent patient is based on the 2017 McDonald diagnostic criteria, as in adults, once the possibility of ADEM or NMOSD has been ruled out. Few data are available from randomized trials to support the use of a specific disease-modifying therapy (DMT) in this population. Interferons and glatiramer acetate are preferred initial choices for DMTs based on observational evidence, with the requirement of a switch to a more effective DMT if breakthrough MS activity occurs.