**11. Conclusion**

Two to 5% of all MS patients have their first attack during childhood or adolescence. Pediatric MS has different clinical features from adult-onset MS, particularly in very young children. ADEM can occur as first attack in children, especially those under 10 years of age. The relapse rate in pediatric MS is higher than in adult MS, but recovery from relapse is better than in adults. However, the onset of secondary progression occurs at a younger age as compared with adult-onset MS. The primary progressive form of MS is extremely rare in pediatric patients. Primary progressive course should suggest other diagnoses in children. Cognitive impairment is one of the most important causes of disability and has different characteris‐ tics from adults. Linguistic dysfunction and decrease in IQ scores can occur during the first year of disease. Despite all these differences from adult MS, the therapeutic approach is based on information in adult MS. There are no randomized controlled trials on efficacy and safety of immunomodulatory and immunosuppressive drugs. Studies on pathogenesis are also limited in pediatric MS. One of the most important differences in the pathogenesis of pediatriconset and adult-onset MS is the presence of anti-MOG antibodies in children. More studies on pathogenesis will provide insight into clinical differences and the development of more safe and effective treatment.
