New Research Puts Pediatric Spin on Environmental Risk Factors and MS
M
ultiple sclerosis is not widely recognized as a vitamin D deficiency, viral exposure and cigarette smoke. childhood disorder. As pediatricians may not In the article, Makhani concluded that place of residence be familiar with MS, diagnosis is often missed early in life might significantly influence future MS risk. or delayed. Studies suggest that two to five percent of all According to one study, pediatric MS patients are more people with MS have a history of symptom onset before age likely to report Caribbean or Asian ancestry compared 18. An estimated 10,000 children have MS in the United to adult-onset MS patients. Along the same lines, pediatStates, and another 15,000 experience other demyelinating ric-onset MS patients born in North America and those disorders that may be related to MS. who spent some or all of their childhood in Canada show One Yale researcher with a focus on pediatrics is shedthat place of residence in childhood is a profound determiding light on key environmental risk factors associated not nant of MS risk. only with multiple sclerosis, but also pediatric MS. The article went on to say that these geographical vari“I was inspired by my research ations in MS prevalence may be mentor, Dr. Brenda Banwell, explained by sunlight exposure and her enthusiasm for studying and vitamin D status. In an exmultiple sclerosis in children,” said perimental autoimmune mouse Naila Makhani, M.D., M.P.H., model of MS, an injection of an Assistant Professor of Pediatrics vitamin D prior to disease inducand Neurology at the Yale Unition proved to prevent the clinical versity School of Medicine. “She manifestation of symptoms and was a pioneer in describing this the development of pathologic disease in children. While I also lesions. This may provide interesthave personal connections to MS, ing insight to environmental exit was Dr. Banwell that helped me posures in relation to an increase to see that children may hold the in MS risk. key to curing MS.” Makhani further deduced that In 2005, Makhani completed studying viral exposures has led her Doctor of Medicine Degree many to the discovery of a link at the University of British Cobetween MS and infection, spelumbia. She went on to earn her cifically with Epstein-Barr Virus Master’s Degree in Public Health (EBV). Testing positive for EBV from Harvard University School appears to increase the risk for of Public Health in 2011. Concuradult-onset MS. In childhood, rently, she completed a two-year case-control studies show that the formal fellowship in pediatric virus is also more commonly demultiple sclerosis and central tected in pediatric-onset patients nervous system inf lammatory than in healthy age- and regionNaila Makhani, M.D., M.P.H., Ph.D. diseases, funded by the Canadian ally-matched children. Network for MS Clinics at the Hospital for Sick Children Lastly, Makhani looked at cigarette smoke in context in Toronto, Canada. In 2013, she received the Young with MS biology. Increased risk for adult-onset MS in inInvestigator Travel Award at the European Congress for dividuals who have a history of smoking has been found in Treatment and Research in Multiple Sclerosis (ECTRIMS) several case-control studies. Consistent with this research, held in Copenhagen, Denmark. studies show that children under the age of 16 diagnosed “As an assistant professor at Yale, I am able to split my with MS were more likely to be exposed to parental smoktime evenly between researching and providing clinical care ing. However, there has not been an established link beincluding my work at the MS Clinic at Yale’s North Haven tween childhood-onset MS and maternal smoking during MS Care Clinic,” said Makhani, whose husband, Nathan pregnancy. Martin, also works at Yale as a music theorist. “I find it “Children with MS have a shorter window than adult very rewarding to see something occurring in a patient, ask patients between exposure to environmental triggers and myself, ‘Why is this happening?’ and then develop a study clinical disease onset,” said Makhani. “That shows me that to try and find an answer.” understanding environmental factors is vital to identifying Makhani has focused on pediatric MS clinical care and and developing preventative strategies for multiple sclerosis.” projects looking at immune cells, MRI imaging features, Makhani is currently taking new patients and can be reached and environmental exposures in children with MS. As the at 203.785.4081. For more information on pediatric MS, lead author of “Environmental Risk Factors for Pediatric please visit www.nationalMSsociety.org. Multiple Sclerosis,” she focused on four topics: geography, 11