multiple sclerosis, the neurological disease once thought to strike adults
only. Researchers in a few medical centers in the United States and Canada say
they're seeing more children like Kyle who are diagnosed with the disease.
And the last thing the young patients want to think about is
a disease that can cause unpredictable bouts of paralysis, numbness, vision loss
and a host of other terrifying symptoms.
MS affects about 350,000 American adults, and experts
estimate that as many as 20,000 children in the United States have the disease
but are undiagnosed. New medical evidence suggests that the number of pediatric
patients is rising -- probably because more doctors are considering the
diagnosis when they see a child with telltale symptoms such as a sudden loss of
vision.
When a childhood diagnosis is made, doctors, parents and
children are faced with a number of unanswered questions. Researchers don't know
whether the drugs used to treat adults will work for children. They don't know
how quickly the disease will progress.
MS occurs when the body's immune cells turn and mistakenly
attack the thick sheath covering the nerve fibers of the brain and spinal cord.
This protective coating, myelin, is like the rubber insulation on an electrical
wire. When it's stripped, the nerve can be damaged, triggering a range of
symptoms such as tremors or slurred speech. But the course of MS doesn't follow
a predictable pattern.
Some people with MS have attacks that can last several days
to a week and then fully recover. They may not get another attack for a year or
even a decade. Others will get several attacks spaced out over a year. A small
number of people with MS get steadily worse with each attack.
Into the unknown
But that's the way the disease progresses for adults. No one
knows what will happen to kids like Kyle. Lauren Krupp at the State University
of New York-Stony Brook and her colleagues just completed a study of 21 kids
with MS, one of the first studies to focus on the disease in children.
Traditionally, neurologists had been taught that MS strikes
adults, most often women, between the age of 20 and 40. But Krupp's study,
sponsored by the National Multiple Sclerosis Society, suggests MS can launch its
attack very early in life: One child in the study was diagnosed at 6.
Other researchers say they've seen the disease in preschool
children. Brenda Banwell, a neurologist at the Hospital for Sick Children in
Toronto, says her team has treated 34 children with MS: The youngest was 4 and
nearly half were under age 10 when they had their first attack.
Kyle Wallace had his first MS attack at age 4, says his
mother, Tammy. She was getting him ready to go to preschool in the morning when
suddenly he couldn't sit up.
Even today, many doctors don't consider MS a possibility in a
child that young, Banwell says. In fact, Tammy Wallace says she has tried to get
help at the local hospital when Kyle has an attack, only to be told there's no
such thing as pediatric MS.
Now she doesn't even try to get help in their suburb outside
Toronto. She drives the 45 minutes to get to Toronto's Hospital for Sick Kids.
That lack of knowledge about pediatric MS means many kids may
not get a diagnosis right away. Only a few doctors at urban centers in the
United States and Canada specialize in pediatric MS. Krupp's group gets kids
from all over the U.S. Banwell's group in Toronto also sees families from all
over Canada and even some from the U.S.
Suffering in silence
Except for some mild tremors, no one would ever guess that
17-year-old Anna Peabody has MS. But Peabody, an honors student at
Acton-Boxborough Regional High School in Acton, Mass., has lived through five
flare-ups in the disease since her diagnosis in 2001.
"It's been awful," she says. "I missed three months of school
last year." Peabody made up that time during the summer and went on with her
classmates.
But researchers can't tell Peabody what the future might
hold. "I worry," she says simply. "Will I be able to walk when I am 20?"
Although most children with MS have very mild cases, both
Krupp and Banwell have seen a small group of kids with very aggressive symptoms.
Instead of one or two attacks a year, these children must deal with five or
more.
Krupp's study identified five out of 21 cases in which the
disease took on this more severe course. No one really knows whether those kids
will go on to experience progressively worsening disease, but Krupp hopes the
arsenal of new drugs that can push back the malady in adults will work the same
way for children.
But the drugs that have fueled a revolution among adults with
MS have not been tested in children. There's no proof that these drugs will work
the same way for kids as young as Kyle Wallace. But doctors like Krupp have no
choice but to use the drugs, especially when faced with a young patient who has
had multiple attacks in a short period.
The hope is that such drugs, especially if started early,
will stave off the worst consequences of the disease. For kids with the worst
attacks, Krupp has even used more than one drug in combination to push the
disease back. That's worked, at least so far.
But even for Krupp, the battle with pediatric MS is a
day-by-day struggle that takes on an air of urgency: Each attack can cause a
little more damage to the brain. Researchers worry that repeated attacks can
leave a child with memory and learning problems. Krupp says about 30 percent of
the children in the study had trouble with cognitive skills, such as remembering
information for a test.
Some adults with MS also have such deficits but often can get
around their problems by relying on their past experience. Unlike adults with MS
who have already completed their academic careers, kids are still trying to lay
down a foundation of knowledge.
And even for children without cognitive damage, the effects
of MS can be devastating. Anna Peabody says that her vision often fades, a
problem that makes reading more than two pages of text almost impossible. But
Peabody refuses to let go of her dream: attending college.
To get there, Peabody says she's had to change her attitude
toward the disease. She says she spent two years denying the existence of her
MS, an effort that exhausted her. Now she accepts the tremor that makes it hard
for her to write a paper.
Watching that struggle can be pure anguish for a parent.
"Your job as a parent is to fix it," her father, George Peabody, says. "And here
comes this disease and we can't make it go away."
But researchers say they're struck by the resiliency that
both children and parents show in the face of the disease.
Tammy Wallace says her son's first attack left the
preschooler unable to walk. She taught him to walk again and told him, "We're
going to beat this."
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