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In childhood, multiple sclerosis (MS) with a primary progressive disease course is very rare.1,2 Therefore, we read the recent article of Abdel-Mannan et al.3 presenting six pediatric patients fulfilling McDonald 2017 criteria for primary progressive MS (PPMS) with great interest. All patients presented with a progressive myelopathy, including progressive balance, and/or lower limb function impairment for at least 1 year. During follow-up, they had an ongoing progressive disease course, without sustained improvement and with a faster decline of Expanded Disability Status Scale (EDSS) compared to pediatric relapsing-remitting MS patients. In the four patients treated with intravenous methylprednisolone (ivMP), this treatment was unsuccessful. Patients continued to progress despite immunomodulatory treatment (azathioprine or hematopoietic stem cell transplantation). Only one patient was started on first-line disease-modifying therapy (DMT) for MS (interferon-beta-1a) but did not tolerate this. Although rare, Abdel-Mannan et al.3 plead for recognition of PPMS in childhood in order to start registered PPMS treatment in these patients in hope to prevent further deterioration.

Pediatric MS patients with a primary progressive-like disease may still have relevant inflammatory activity and may benefit from regular MS treatment