Ryan Cappa1, Liana Theroux1, J Nicholas Brenton2. 1. Department of Neurology, Division of Pediatric Neurology, University of Virginia, Charlottesville, Virginia. 2. Department of Neurology, Division of Pediatric Neurology, University of Virginia, Charlottesville, Virginia. Electronic address: jnb8h@virginia.edu.
Abstract
BACKGROUND: Pediatric multiple sclerosis is an increasingly recognized and studied disorder that accounts for 3% to 10% of all patients with multiple sclerosis. The risk for pediatric multiple sclerosis is thought to reflect 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. Genetic predisposition contributes to the risk of multiple sclerosis, and the major histocompatibility complex on chromosome 6 makes the single largest contribution to susceptibility to multiple sclerosis. With the use of large-scale genome-wide association studies, other non-major histocompatibility complex 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, which are environmentally-influenced mechanisms through which gene expression may be modified. CONCLUSIONS: This article will review these topics to provide a framework for discussion of a comprehensive approach to counseling and ultimately treating the pediatric patient with multiple sclerosis.
BACKGROUND:Pediatric multiple sclerosis is an increasingly recognized and studied disorder that accounts for 3% to 10% of all patients with multiple sclerosis. The risk for pediatric multiple sclerosis is thought to reflect 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. Genetic predisposition contributes to the risk of multiple sclerosis, and the major histocompatibility complex on chromosome 6 makes the single largest contribution to susceptibility to multiple sclerosis. With the use of large-scale genome-wide association studies, other non-major histocompatibility complex 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, which are environmentally-influenced mechanisms through which gene expression may be modified. CONCLUSIONS: This article will review these topics to provide a framework for discussion of a comprehensive approach to counseling and ultimately treating the pediatric patient with multiple sclerosis.
Authors: Prince Sebastian; Nicolas Cherbuin; Lisa F Barcellos; Shelly Roalstad; Charles Casper; Janace Hart; Gregory S Aaen; Lauren Krupp; Leslie Benson; Mark Gorman; Meghan Candee; Tanuja Chitnis; Manu Goyal; Benjamin Greenberg; Soe Mar; Moses Rodriguez; Jennifer Rubin; Teri Schreiner; Amy Waldman; Bianca Weinstock-Guttman; Jennifer Graves; Emmanuelle Waubant; Robyn Lucas Journal: Neurology Date: 2021-12-08 Impact factor: 9.910