A team of researchers with University Medical Center Göttingen, Georg August University Göttingen, has found that overweight and obese children are at higher risk of developing the relapsing form of multiple sclerosis (MS) – and they are also less receptive to medications meant to treat the disease.
In their paper published in the Journal of the American Medical Association, the group describes their study of the medical records of 453 children diagnosed with MS before the age of 18 and what they learned.
MS is a demyelinating disease in which the insulating sheaths around nerves are damaged, preventing the nerves from working properly.
Impacted areas can vary, as can symptoms.
It is an incurable disease, but can be treated to reduce damage and symptoms.
There are also two kinds of MS – relapsing and progressive.
As the names suggest, those with the relapsing form go through periods when the disease is active and times when it is not.
Those with the progressive form are much worse off – once it starts, it never stops. Symptoms and damage grow progressively worse.
In this new effort, the researchers sought to gain a better perspective on the disease in children.
To learn more about which children are most at risk of developing the relapsing form of MS, the researchers studied the health records of 453 children in Germany’s Center for MS in Childhood and Adolescence in Göttingen.
The researchers found that 13 percent of the children with MS were overweight (they had a body mass index in the 90th to 97th percentile) and 14.8 percent of them were obese (having a body mass index over the 97th percentile).
This finding alone suggested that obesity in children puts them at greater risk of developing MS.
The researchers also found that these children did not respond as well to medications and had higher relapse rates.
And those who were the most obese had the worst relapse rates.
The researchers also looked at the results of MRI tests carried out on the children at diagnosis, during intervals and during a relapse.
They report finding no evidence of a higher-than-normal active inflammatory response in children with a high BMI.
Babies, children, and teenagers
MS in babies, children, and teens is similar to MS in adults. However, there are some differences:
- Compared with adults, children likely experience more frequent relapses — during which symptoms worsen significantly — one study suggests.
- Another study reports that children with MS take more time to reach motor disability milestones than adults with MS.
- However, the same study notes, children with MS still reach the milestones at a younger age than people who receive a diagnosis in adulthood.
- According to one study, lesions on the brain that result from MS were more inflamed in children with the disease, compared with adults.
- Children and juveniles with MS tend to experience difficulties with functions such as memory, concentration, and language within about 2 years of their diagnosis.
- The same research indicates that fatigue and depression may also arise during this time frame.
Learning about these characteristics can help children, parents, and caregivers better understand the disease and its progression.
The medical community is still unsure about what causes MS.
Some potential risk factors include:
- family history
- vitamin D deficiency
- the onset of puberty in females
- exposure to the Epstein-Barr virus
- exposure to secondhand smoke
A person may experience vision changes as an early symptom of MS.
Symptoms of MS in children are similar to those in adults. Some common symptoms include:
- difficulty walking
- difficulty with bowel and bladder control
- changes in vision
- muscle spasms
- tingling or numbness in the limbs, face, and other parts of the body
- changes in sensory perception
In addition, young children are more likely to experience confusion and coordination problems.
Treatments for MS in adults and children do not vary greatly, and a doctor may prescribe several of the same medications.
One of the first treatments that healthcare providers typically try involves using interferon beta 1-alpha or glatiramer acetate.
These are self-injected medications that help with limiting or eliminating symptoms associated with MS.
The Food and Drug Administration (FDA) have not approved either interferon beta 1-alpha or glatiramer acetate for use in children, but doctors often recommend these medications for off-label use.
When first-line therapies do not work or are not sufficiently effective, a doctor may recommend additional treatments.
In 2018, the FDA approved the use of fingolimod, an oral medication, for children aged 10 or older who had relapsing-remitting MS.
The FDA first approved this drug for use in adults with the condition in 2010. It helped increase the amount of time between relapses and reduced the activity of the disease.
Researchers are looking into additional oral medications for children and adolescents. For example, some are investigating MS-related uses of rituximab, a medication that can help treat autoimmune disorders in children.
Children and teenagers who have MS may also benefit from therapy that addresses mental health. MS is a life-long condition and symptoms tend to get worse.
This can be a source of anxiety and may lead to depression.
It is important for parents and caregivers to encourage children and teens to speak about any fears and concerns and to help provide supportive therapy, when necessary.
More information: Brenda Huppke et al. Association of Obesity With Multiple Sclerosis Risk and Response to First-line Disease Modifying Drugs in Children, JAMA Neurology (2019). DOI: 10.1001/jamaneurol.2019.1997
Journal information: Journal of the American Medical Association , Archives of Neurology