Medical Overview and Epidemiology

White matter provides for information transfer in the brain, whereas gray matter is involved in information processing. Myelination in the brain continues past the second decade, in contrast to the development of other brain neurons, and normal development is affected by pediatric illness and injury. The development of myelin may be related to the appearance of more mature aspects of personality like motivation, comportment, and executive functioning. All of these skills are related to the frontal lobe, which leads to the hypothesis that white matter tracts connect the frontal lobes to other regions of the brain and are therefore responsible for the development of adult behavior. There are more than 100 cerebral white matter disorders that can be classified as genetic, demyelinative, infectious, inflammatory, toxic, metabolic, vascular, traumatic, neoplastic, and hydrocephalic. Characteristic patterns of neurobehavioral dysfunction are evident in all of these disorders regardless of the etiology and demonstrate the importance of white matter in the development of high brain functioning. Disorders and diseases of white matter that affect children include the following: metachromatic leukodystrophy, globoid cell leukodystrophy, X-linked adrenoleukod-ystrophy, vanishing white matter disease, Pelizaeus-Merzbacher disease, Alexander disease, Canavan disease, and acute disseminated encephalomyelitis. These disorders are genetic in origin and are typically diagnosed in the first 5 years of life. Multiple sclerosis is among the most common demyelinating diseases in children and presents with isolated symptoms that may include optic neuritis, sensory signs, encephalopathy, ataxia, seizures, and brain stem disorders (Cecil and Kos 2006). Although multiple sclerosis primarily affects young adults between the ages of 20 and 40 years, 2%-5% of all patients with multiple sclerosis experience symptoms prior to age 16 years (Ness et al. 2007).

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