Disease-Modifying Therapy of Pediatric Multiple Sclerosis

Chitnis, Tanuja

doi:10.1007/s13311-012-0158-1

Cited by 29 publications

(54 citation statements)

References 90 publications

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“…Children with MS tend to have a lower supratentorial T1 lesion burden, possibly reflecting a more effective remyelination and repair in brain regions still engaged in active primary myelination. 17 To our knowledge, there are no available controlled studies regarding the efficacy of immunomodulatory treatments in this age group 12 and use of these treatments is mostly based on retrospective, observational studies. In our patients, there was a global preference for the best known, and longer in use, interferons and glatiramer acetate.…”

mentioning

confidence: 99%

Pediatric Multiple Sclerosis in Portugal: A Multicentre Study

Correia

Augusto²,

Meireles³

et al. 2016

Acta Med Port

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RESUMOIntrodução: A esclerose múltipla é habitualmente diagnosticada em adultos jovens mas, mais raramente, pode manifestar-se durante a infância ou adolescência. Os dados sobre a esclerose múltipla pediátrica em Portugal são escassos. O objectivo principal deste estudo é a avaliação das características demográficas, clínicas, laboratoriais e neurorradiológicas da esclerose múltipla de início em idade pediátrica em Portugal. Os objetivos secundários consistem na comparação entre a esclerose múltipla de início na infância e a esclerose múltipla de início na adolescência e na caracterização dos tratamentos prescritos. Material e Métodos: Realizou-se um estudo retrospectivo, observacional e multicêntrico, que consistiu na análise dos dados de todos os doentes com apresentação da EM antes dos 18 anos. Resultados: Incluíram-se 46 doentes (72% do sexo feminino), com uma idade média de diagnóstico de 16,1 anos. Seis casos tiveram início na infância, 40 na adolescência. A esclerose múltipla apresentou-se em 98% dos casos com a forma surto-remissão. O estudo do líquor revelou bandas oligoclonais em 74% dos doentes. A ressonância magnética encefálica mostrou predominantemente lesões supratentoriais (98% dos casos), enquanto que a ressonância medular revelou que o segmento cervical foi o mais frequentemente afectado. Todos os doentes iniciaram terapêutica imunomoduladora (75% com interferão β). Relativamente às diferenças entre os dois grupos etários, encontrámos uma maior proporção de doentes do sexo masculino e com pleocitose no grupo com apresentação na infância. Discussão: Este trabalho fornece novos dados sobre as características da esclerose múltipla pediátrica em Portugal e os resultados são semelhantes aos reportados em outras partes do mundo. Conclusão: Este é o primeiro estudo multicêntrico português sobre a esclerose múltipla com apresentação na infância e adolescência. Mais estudos são necessários para clarificar os mecanismos subjacentes às particularidades da esclerose múltipla pediátrica. Palavras-chave: Adolescente; Criança; Esclerose Múltipla; Portugal. ABSTRACT Introduction:Multiple sclerosis is most often diagnosed among young adults but less frequently it may present during childhood or adolescence. In Portugal, there has been only one previous single-center, pediatric multiple sclerosis study. The main objective was the evaluation of the demographic, clinical, laboratorial and neuroradiological characteristics of patients with pediatric-onset multiple sclerosis in Portugal. The secondary objectives were to compare the characteristics of childhood-onset multiple sclerosis and adolescent-onset multiple sclerosis and to characterize the treatments prescribed. Material and Methods:We performed a retrospective observational, multicentric study. We reviewed data of all patients with multiple sclerosis younger than 18 years at the onset of their first multiple sclerosis symptoms. Results: There were 46 patients (72% female) included with a mean age at diagnosis of 16.1 years. Six cases had childhood-onset and...

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mentioning

confidence: 99%

Pediatric Multiple Sclerosis in Portugal: A Multicentre Study

Correia

Augusto²,

Meireles³

et al. 2016

Acta Med Port

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“…The relapsing-remittent (RR) form is most common among children (more than 85% of all patients) (6,35). Patients with RR MS have no increased risk of advancement to the secondary progressive form despite the growth of the degree of disability (36).…”

Section: Clinical Characteristics: Children Versus Adultsmentioning

confidence: 99%

“…Patients with RR MS have no increased risk of advancement to the secondary progressive form despite the growth of the degree of disability (36). Recurrence rates in the pediatric population are higher in the first 3 years than in adults (6). However, the recovery period following a relapse is much shorter in children (1).…”

Section: Clinical Characteristics: Children Versus Adultsmentioning

confidence: 99%

“…Children, however, differ from adults in many physiological and developmental issues, resulting in significant discrepancy for drug efficacy and safety, as well as treatment response. The altered immunomodulatory treatment response in MS may be significantly affected by higher level of CNS inflammation and the differences in neurological damage intensity, restorative capacity, and plasticity (43), as well as by the different immunopathobiological mechanism in children versus adults (6).…”

Section: Treatment Of Pediatric Msmentioning

confidence: 99%

“…The subsequent decades witnessed extensive etiological, pathophysiological, and pharmacological studies regarding MS, from the discovery of its genetic basis to the implementation of immunomodulatory therapy (3)(4)(5). In recent years, diagnosis and treatment of pediatric MS has drawn attention of the scientific community (6). The clinical characteristics, laboratory analyses, and neuroimaging techniques may significantly differ in children versus adults (7), whereas an individual approach remains crucial for the early diagnosis, as well as for the treatment of pediatric MS.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Multiple Sclerosis Therapies in Pediatric Patients: Challenges and Opportunities

Jančić

Nikolić

Ivančević

et al. 2017

Multiple Sclerosis: Perspectives in Treatment and Pathogenesis

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Multiple sclerosis (MS) is an autoimmune, chronic, inflammatory, and demyelinating disease of the central nervous system (CNS). The etiology of MS is most likely multifactorial; it is dependent on genetic, autoimmune, and environmental factors, with a variable course among patients. The two main clinical events that characterize MS are relapses and progression. In recent years, diagnosis and treatment of pediatric MS has drawn attention of the scientific community. Management of pediatric MS focuses on reducing relapses and symptoms via administration of disease-modifying drugs (DMDs) and specific symptomatic treatment. A multidisciplinary approach to pediatric MS treatment is preferred, which aims at alleviating and preventing the accumulation of neurological deficits. MS therapy should be based on DMDs, that is, immunomodulatory drugs. These drugs, which sequester immune system activity, are further subdivided into two categories: first-line and second-line immunomodulatory therapy. First-line immunomodulatory therapy (interferon beta-1a, interferon beta-1b, Multiple Sclerosis in Pediatric Patients 40and glatiramer acetate) is ineffective (either no response or partial response) in roughly 30% of patients. Patients with a poor response to first-line therapy require second-line immunomodulatory therapy (natalizumab, mitoxantrone, fingolimod, teriflunomide, azathioprine, rituximab, dimethyl fumarate, daclizumab, alemtuzumab, and ocrelizumab). In addition to immunomodulatory drugs, treatment of relapses also involves the use of high intravenous doses of corticosteroids, administration of intravenous immunoglobulins, and plasmapheresis.

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