The course of pediatric-onset multiple sclerosis and adult multiple sclerosis shows some clinical differences. The rate of having a second attack after the first clinical event is 80% in children and around 45% in adults but the time to the second event is similar in all age groups. The pediatric group usually has a more aggressive onset than adults. On the other hand, a higher rate of complete recovery is observed in pediatric-onset multiple sclerosis after the first clinical event compared to the adult group. Despite a highly active initial disease course, pediatric-onset multiple sclerosis patients show a slower increase in disability than patients with adult-onset disease. This is thought to be due to greater remyelination capacity and plasticity of the developing brain. The management of pediatric-onset multiple sclerosis includes safety issues as well as effective disease control. In the pediatric-onset multiple sclerosis group, similar to adult multiple sclerosis, injectable treatments have been used for many years with reasonable efficacy and safety. Since 2011, oral treatments and then infusion treatments have been approved and used effectively in adult multiple sclerosis and have gradually entered clinical use in the pediatric-onset multiple sclerosis group. However, clinical trials are fewer, smaller, and include shorter follow-up due to the much lower prevalence of pediatric-onset multiple sclerosis than adult multiple sclerosis. This is particularly important in the era of recent disease-modifying treatments. This review of the literature presents existing data on the safety and efficacy of fingolimod, pointing to a relatively favorable profile.
Multiple sclerosis (MS) is an immune-related chronic disease with demyelination and loss of axonal in the central nervous system and is an important cause of disability in young adults. This description has been applied to MS for many years. Disease-modifying therapies (DMTs) are used in MS to reduce the relapse rate and improve quality of life. It comprises immunomodulators and immunosuppressants. The hypothesis of treatments aimed at preventing new lesions and sequelae, and slowing the poor course of the disease remains a current one. Over time, the MS patient profile has changed, the rate of physically disabled patients has decreased, and the rate of ambulatory patients has increased. 1 The effectiveness of interferon-beta (IFN-B), the first of the self-injectable DMTs, was evaluated regarding the presence of attack in the first year, disease progression with the expanded disease status scale (EDSS), and the presence of new T2 lesions on magnetic resonance imaging (MRI) of the brain. 2 While disease activity and progression were previously evaluated using
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