Pediatric Multiple Sclerosis: Genes, Environment, and Comprehensive Therapeutic Approach

Publication date: Available online 13 July 2017
Source:Pediatric Neurology
Author(s): Ryan Cappa, Liana Theroux, J. Nicholas Brenton
Background: Pediatric multiple sclerosis (MS) is an increasingly recognized and studied disorder that affects 3-10% of all patients. The risk of pediatric MS is thought to be secondary to a complex interplay between environmental and genetic risk factors. Main Findings: Environmental exposures, including sunlight (ultraviolet radiation, vitamin D levels), infections (Epstein-Barr virus), passive smoking, and obesity, have been identified as potential risk factors in youth. There is great interest in the potential of modifying these known risk factors (vitamin D status) in attempts to improve disease course, though much work is still needed. Genetic predisposition plays a known contribution to MS risk, and the major histocompatibility complex on chromosome 6 makes the single largest contribution to MS susceptibility. With the use of large-scale genome-wide association studies, other non-MHC alleles have been identified as independent risk factors for the disease. The bridge between environment and genes likely lies in the study of epigenetic processes – environmentally-impacted mechanisms through which gene expression may be modified. Conclusions: This article will review these topics to provide a framework for discussion on the comprehensive approach in counseling and ultimately treating the pediatric MS patient.



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