Pediatric Multiple Sclerosis and Related Neuroimmune Disorders Clinic
The Pediatric Multiple Sclerosis and Related Neuroimmune Disorders Clinic is a multidisciplinary clinic within UT Health Austin Pediatric Neurosciences at Dell Children’s, a clinical partnership between Dell Children’s Medical Center and UT Health Austin.
Our nationally recognized providers take a family-centered approach to diagnosing and treating children of all ages with neuroimmunology disorders, including multiple sclerosis (MS). With our providers’ experience, our collaborative approach, and our advanced technology, we provide a wide range of services from diagnosis to disease management, rehabilitation, and more. Our goal is to achieve the best outcomes for your child so they can be as happy, healthy, and independent as possible.
With access to expert staff and advanced technology for treating both acute and chronic neurological conditions, our highly specialized physicians provide a wide range of services from evaluation, testing, and diagnosis to surgical treatment, disease management, rehabilitation, and more to give patients and their families the best quality of life.
Multiple Sclerosis and Related Neuroimmune Disorders
Pediatric onset multiple sclerosis (PoMS) is a demyelinating disorder of the central nervous system (the brain, spinal cord, and optic nerves). Children develop PoMS when their immune system attacks myelin, the protective coating around their nerve cells in the central nervous system. This destructive process, called demyelination, prevents the brain from communicating properly with the rest of the body. As a result, children develop symptoms such as vision loss, double vision, weakness, numbness/tingling sensations, and bowel or bladder dysfunction.
Although multiple sclerosis (MS) is more common in adults, about 5 to 10 percent of all people with MS have PoMS. A neurologist diagnoses PoMS by performing an examination, taking a medical history, and performing neurodiagnostic tests, including magnetic resonance imaging (MRI) of the brain and spine and cerebrospinal fluid analysis, in some cases. The most common treatment for PoMS is immune-modulating therapy, which alters the immune system to prevent it from attacking the nerve cells.
Myelin oligodendrocyte glycoprotein associated disorder (MOGAD), also known as MOG antibody disease, is an acquired demyelinating syndrome. “Acquired” means the defective gene that causes the disorder is passed down from at least one parent. “Demyelinating” refers to myelin, the protective coating around nerves in the central nervous system. In children with MOGAD, the immune system produces antibodies to attack MOG, a protein on the surface of the myelin. This creates inflammation in the central nervous system, which includes the brain, spinal cord, and optic nerves.
About one-third of all children with an acquired demyelinating syndrome like MOGAD have antibodies to the MOG protein. When these antibodies attack MOG, it can lead to symptoms such as vision loss, mental changes, an altered level of consciousness, seizures, weakness, balance issues, numbness and tingling in the arms and legs, and bowel or bladder dysfunction. To diagnose MOGAD, your child’s neurologist will look for these symptoms and perform neurodiagnostic tests, including blood tests to detect the MOG antibody.
Immunotherapy is the most common treatment for MOGAD. Because this disorder is usually monophasic, meaning it occurs only once, not all children require ongoing immunotherapy. Children with relapsing disease, however, may require long-term immunotherapy.
Neuromyelitis optica spectrum disorder (NMOSD) is a rare demyelinating disorder that creates inflammation in the spinal cord and the optic nerves, although inflammation of the brain can occur sometimes. Because it primarily attacks the optic nerves, it can cause vision loss and blindness. Other symptoms include weakness, spasms, numbness, paralysis, seizures, nausea, confusion, and bowel and bladder dysfunction.
The disorder is usually relapsing, meaning the attacks can reoccur months or years apart. Diagnosis is made through a medical history, lab tests, and imaging. Treatment may include anti-inflammatory drugs, plasma exchange, and immunosuppressants. Starting long-term immunotherapy early prevents potentially disabling relapses.
Acute disseminated encephalomyelitis, or ADEM, is a demyelinating condition that causes inflammation of the brain, spinal cord, and optic nerves. Like MOGAD, many children with ADEM produce antibodies that attack the MOG protein on myelin.
The disorder most commonly affects children younger than 12 years old. About half of the children develop ADEM shortly after infection. Symptoms include altered mental status, change in the level of consciousness, poor balance, vision changes, weakness, severe headaches, fever, tingling and prickling sensations, and bowel or bladder dysfunction. These symptoms, along with other tests such as brain MRI and cerebrospinal fluid analysis, help us diagnose the disorder.
ADEM is monophasic (occurs only once) and involves an intense but brief attack. In rare cases, however, attacks can reoccur. Treatment includes anti-inflammatory drugs, plasma exchange, and immunoglobulin therapy (IVIG, an IV antibody therapy). Most children do not require long-term immunotherapy.
Autoimmune encephalitis (AE) is a disorder in which the immune system attacks the brain, causing it to become inflamed. The inflammation leads to symptoms such as altered mental status, seizures, movement disorders, speech changes, psychiatric symptoms such as aggression and delusions, and dysautonomia, a disorder that affects involuntary functions like breathing and heart rate. Early recognition and treatment help ensure your child has the best possible outcome. AE treatment requires a multidisciplinary approach, like the approach we take at our clinic. This includes psychiatry, psychology, physical medicine and rehabilitation, and rheumatology.