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This review discusses the epidemiologic factors involved in the pathogenesis of pediatric multiple sclerosis (MS), which have been the focus of numerous studies in the last several years. We also review the clinical features (including diagnostic evaluation and differential diagnosis) of, treatment approach to, and prognosis of pediatric MS.Up to 10% of patients with MS have their initial demyelinating before the age of 18 years. Over the past 15 years, international and collaborative studies have identified an increasing number of genetic and environmental risk factors for pediatric MS. Identification of these risks and their interplay allow for better understanding of the pathophysiology of pediatric MS, which may inform subsequent treatment and disease management. Careful attention to the management of relapses and chronic symptoms, including implementation of lifestyle modifications and pharmacologic interventions, enables improved school performance and quality of life.Ongoing research in the field of pediatric MS aims to better understand the epidemiologic factors involved in the pathobiology, safety and efficacy of disease-modifying treatments, and long-term prognosis, particularly of cognitive development and academic potential. Collaborative, multinational studies will enable the advancements needed to truly optimize clinical care for this population.