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This chapter articulates the clinical manifestations of multiple sclerosis (MS) in children. Defining the clinical features of MS in children is challenged by the variability of the available literature with respect to consistency in the definition of clinical features and diagnostic criteria for pediatric MS; age of inclusion; duration of clinical observation, a key issue in recognizing features that may not be present at onset or may change during the course of MS in children; and definition of disease onset. Impairment of executive functions, processing speed, working memory, and low functioning in activities related to school performances have been described in children with MS. Kurtzke's Functional System and Expanded Disability Status Scale (EDSS) is the most widely used scale to score neurological impairment in pediatric and adult MS patient. A key facet of care of children with MS involves the use of medications aimed at the reduction of relapse rate.