Multiple Sclerosis in Pediatrics: Current Concepts and Treatment Options

Abstract

Multiple sclerosis (MS) is a chronic, autoimmune, inflammatory, demyelinating disease of the central nervous system. MS is increasingly recognized in the pediatric population, and it is usually diagnosed around 15 years of age. The exact etiology of MS is still not known, although autoimmune, genetic, and environmental factors play important roles in its development, making it a multifactorial disease. The disease in children almost always presents in the relapsing-remittent form. The therapy involves treatment of relapses, and immunomodulatory and symptomatic treatment. The treatment of children with MS has to be multidisciplinary and include pediatric neurologists, ophthalmologists, psychologists, physiotherapists, and if necessary, pediatric psychiatrists and pharmacologists. The basis of MS therapy should rely on drugs that are able to modify the course of the disease, i.e. immunomodulatory drugs. These drugs can be subdivided into two general categories: first-line immunomodulatory therapy (interferon beta-1a, interferon beta-1b, glatiramer acetate) and second-line immunomodulatory therapy (natalizumab, mitoxantrone, fingolimod, teriflunomide, azathioprine, rituximab, dimethyl fumarate, daclizumab). Treatment of relapses involves the use of high intravenous doses of corticosteroids, administration of intravenous immunoglobulins, and plasmapheresis. We summarize here the current available information related to the etiology and treatment options in MS. Early administration of immunomodulatory therapy is beneficial in adults, while more studies are needed to prove their effectiveness in pediatric populations. Therefore, pediatric MS still represents a great challenge for both, the early and correct diagnosis, as well as its treatment.

Early and Long Term Outcomes of Patients with Diagnosed Acquired Demyelinating Syndromes

“…Multiple skleroz, çocukluk çağında 15 yaş civarında tanı almakta, 10 yaşının altında çok nadir görülmektedir. Çocukluk çağında MS, neredeyse her zaman relapsing-remitting olarak seyretmektedir (15) . Tedavide, atak sırasında pulse steroid, IVIG veya plazmaferez, uzun dönem tedavisinde hastalığı modifiye edici ilaçlar önerilmektedir (16) .…”

Trial of Fingolimod Versus Interferon Beta-1a in Pediatric Multiple Sclerosis

“…Although multiple sclerosis (MS) typically occurs in young adulthood, approximately 3-5% of cases may start in childhood or adolescence (1). In this age group, relapsing-remitting MS (RRMS) is usually seen (2).…”

Multipel Sklerosis pada Anak

“…2 Penyakit ini umumnya mengenai kelompok pasien usia dewasa muda (antara 30 sampai 40 tahun), dengan prevalensi umum di seluruh dunia adalah 30 kasus per 100.000 populasi; dan hanya sekitar 2-5% penyakit ini terjadi pada usia kurang dari 18 tahun. [3][4][5] Rerata usia saat munculan onset penyakit MS adalah 14 tahun. Insidensi tahunan penyakit MS pada populasi anak bervariasi antara 0,07 hingga 2,9 tiap 100.000 anak.…”

“…Faktor lingkungan yang diperkirakan berperanan penting adalah infeksi virus Epstein-Barr, rendahnya kadar vitamin D dan kebiasaan merokok. 4 Terjadinya penyakit MS diperkirakan dimulai dengan adanya kontak dengan faktor pemicu (agen infeksi) yang menyebabkan sistem imun mengaktivasi kondisi autoreaktifitas melalui aktivasi sel T CD4 (+) di sirkulasi sistemik. Sel T CD4 (+) ini dengan bantuan IL-23 kemudian berdiferensiasi menjadi sel T helper (Th17) yang selanjutnya memproduksi IL-17.…”

“…Produksi sejumlah sitokin proinflamasi pada peradangan ini menyebabkan kerusakan myelin dan Laporan Kasus oligodendrosit yang selanjutnya membentuk plaque sklerotik. 4 Penyakit multipel sklerosis pada populasi anak merupakan suatu kelompok penyakit demielinisasi idiopatik yang jarang ditemukan dan memiliki sejumlah variasi gejala klinis; gejala tersebut meliputi : defisit sensorik, neuritis optikum, defisit motorik, gangguan gait (pola berjalan) dan juga rasa pegal. 5 Kepustakaan lainnya secara lebih sederhana menyatakan MS pada populasi anak memiliki tiga gejala pokok yang meliputi gangguan penglihatan, defisit neurologis dan gangguan mental.…”