The diagnosis and treatment of multiple sclerosis has improved dramatically in the last several years, in both adults and children. Most discussions of multiple sclerosis center on secondary prevention with agents intended to prevent disease progression and limit the ultimate severity of neurological disability. Such disease-modifying treatments are particularly important for children, because children with multiple sclerosis have more years to accumulate lesions. What is not often discussed, however, is primary prevention strategies for multiple sclerosis.
In a Frontiers in Neurology article, Duriel Hardy, MD, and colleagues take a critical look at the difficult topic of multiple sclerosis risk factors that might be modified in the pediatric population. Concern about exposure to Epstein-Barr virus, inhalation of passive cigarette smoke, and exposure to other environmental toxins is bolstered by considerable statistical evidence. An increased body mass index also seems to increase the multiple sclerosis risk, albeit at a lower level.
Although the studies are inconsistent, preliminary evidence suggests that breastfeeding protects against development of multiple sclerosis (possibly by avoiding molecular mimicry between cow milk proteins and brain antigens). Other possible protective factors include sun exposure and higher serum vitamin D levels.
Although many of these factors are modifiable, altering them would require extensive public health changes.
Hardy D, Chitnis T, Waubant E, Banwell B. Preventing multiple sclerosis: the pediatric perspective. Front Neurol 2022;13:802380. doi: 10.3389/fneur.2022.802380
