PPMS in children is different than in adults.

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The good news is that children PPMS responds to RRMS medications.

https://journals.sagepub.com/doi/full/1 ... 8520921367

Interestingly, in contrast to the continuing progression Abdel-Mannan et al.3 described in all their patients despite treatment (no DMTs), our patients stabilized after starting second-line DMTs.

Directly after MS diagnosis, both were started on Natalizumab, and recently one patient changed to Fingolimod due to positive John Cunningham virus. Within a follow-up of 2.1 years after starting treatment, a relevant improvement in EDSS was observed from 3.5 to 3.0 and 4.0 to 3.5, respectively. In addition, they had no relapses and MR imaging of brain and spinal cord showed no new lesions during follow-up.

Even though they presented with a primary progressive-like disease course and did not respond well to steroids; in our opinion, the observed response to second-line DMTs may indicate relevant inflammatory activity in these pediatric patients. This is in line with the higher inflammatory activity observed in pediatric compared to adult MS patients with a relapsing disease course.4,5 In conclusion, in our view pediatric MS patients with a primary progressive-like disease course differ from adult PPMS patients. Therefore, we argue that all pediatric MS patients with a primary progressive-like disease course should receive regular first-line or second-line MS treatment.