Rachel Zolno, MD, Assistant Professor, Neurology, at the Icahn School of Medicine at Mount Sinai, is bringing a new dimension to identifying and managing multiple sclerosis in youngsters, underscoring the benefits of a center that offers the latest treatments and a wide range of services in one place.
“Most people, even a lot of physicians, don’t realize that children can get MS,” says Dr. Zolno, who joined the Corinne Goldsmith Dickinson Center for Multiple Sclerosis in 2024. As many as 10 percent of the people living with MS in the United States have Pediatric-Onset MS (POMS).
“The addition of a pediatric MS/neuroimmunologist specialist serves to broaden our reach and allows us to serve a larger segment of the population,” says Center Director Fred D. Lublin, MD. “Importantly, this gives us an expanded window into the origins of MS, which appear to occur, at least in part, during childhood.”
Rachel Zolno, MD
While most people under age 18 who have POMS are in their late teens, Dr. Zolno has seen children as young as four years old. “It’s rare to find very young children with MS, which is why we want to exclude everything else before we make the diagnosis,” she says.
People in their 20s and 30s comprise the most prevalent age group for first diagnoses of MS. Confirmation three years ago of a strong connection between the Epstein-Barr virus or mononucleosis and MS is one indicator that ailments experienced at younger ages may be precursors to presenting MS.
“With relapsing-remitting MS, when someone looks back they may realize that when they were 14 or 16, they had a few weeks or a couple of months when their arm was really tingly, but they didn’t think much of it as the symptoms went away,” says Dr. Zolno. “MS is not on the radar of pediatricians. It’s not something they look for when a 16-year-old has vague neurologic symptoms.”
Early diagnosis is as important for children as for adults to determine if someone has MS and, if confirmed, to begin a treatment to prevent progression of the disease. Among children, the diagnosis sometimes can be more challenging as there are other diseases affecting the nervous system that may mimic MS and are more common in kids, such as Myelin Oligodendrocyte Glycoprotein Antibody Disease (MOGAD) and Neuromyelitis optica (NMO), other nervous system abnormalities. A physician will want to rule out those diseases before concluding an MS finding.
How MS evolves in youths and adults is different. MS in people under the age of 18 “tends be slightly more aggressive” because they “have strong immune systems,” says Dr. Zolno. But managing the disease can be easier among youths. “Children’s bodies are really resilient, so when they are in the relapsing-remitting stage, and not in the middle of a flare, they can recover a lot better because they are younger.”
After diagnosis, an MS pediatric neurologist may prescribe a disease-modifying therapy (DMT) to manage the disease. “MS is a lifelong disease process,” says Dr. Zolno. “We want to recognize the disease as early as we can so that we can start children on treatment as early as possible to prevent relapses from happening and prevent any sort of disability. They are going to be in treatment for the rest of their lives.”
The Food and Drug Administration has approved only one medication for POMS patients (fingolimod). However, depending on a physician’s assessment, other approved therapies that are used mainly for adult patients may be prescribed, such as B-cell medications like rituximab. “The POMS research community has determined that it is better to use higher efficacy medications earlier to prevent any accrual of disease in pediatric patients,” she says.
Dr. Zolno joined the Center staff in September 2024. “I love the fact that with MS you get to stay with your patients for a long time,” she says. “Of course, I don’t stay with my patients forever, as they eventually will go to an adult doctor.”
Her interest in neurology and POMS began when she was as young as some of her patients. “I actually knew I wanted to be a pediatric neurologist since I was in high school,” she says. Meeting teenagers newly diagnosed with MS, along with having a pediatric MS neurologist as her mentor during residency, gave her further inspiration.
As recognition that MS can occur in children and teens has grown, interest in pediatric MS among aspiring neurologists has risen, says Dr. Zolno.
“There are not many of us treating POMS. It’s a growing field, but it can be hard to find an institution where you get the kind of support that a comprehensive MS care center can provide,” she says.
“The great thing about the Center is that even though I come from the pediatric neurology world, I am still part of the Center. My patients are able to see the Center’s social workers, psychologist, neuropsychologists and other specialists. It’s so important to have access to that multidisciplinary care, for pediatric patients as well.”
By Kenneth Bandler, a multiple sclerosis patient, advocate, and member of the Corinne Goldsmith Dickinson Center for Multiple Sclerosis Advisory Board.