Multiple sclerosis in children – a current review

Abstract: Multiple sclerosis is a progressive, demyelinating disease of the central nervous system, characterised by the occurrence of multifocal and multiperiodic lesions in the brain and the spinal cord. The spectrum of symptoms may include disorders of: eye, sphincter’s control, motor coordination, exteroceptive sensation, paresis of the limbs and cognitive impairment. Children accounts for 2-4% of all MS patients. Boys are affected by the disease slightly more often (1:0.8 in relation to girls), however, in children above six years of age, this trend begins to reverse and in group above ten years of age, girls are affected more than twice as often as boys. The etiology of MS is not sufficiently known. Combination of environmental, genetic and autoimmune factors is postulated. It has been proven that in children with already diagnosed MS antibodies against EBV are detected more frequently. There was no correlation with vaccinations found. There are four forms of classical MS: relapsing-remitting, secondary progressive, primary progressive and progressive relapsing. In children, relapsing-remitting form is the most often. Relapses at the beginning of the disease are more frequent than in adults, but neurological changes almost always withdraw. Diagnosis is primarily based on McDonald’s criteria. Changes in the brain in younger children found in MRI are usually larger, less sharply demarcated, confluent, but may regress. As in adults, the corticosteroids are used to suppress the relapse. Complementary symptomatic treatment is rarely used and a well-chosen rehabilitation is preferred. Disease modifying drugs that are well tolerated by children are interferon ß and glatiramer acetate. There are limited data from clinical trials on the use of second-line drugs in children.

Marcin Kulczynski, Mateusz Tomaszewski, Robert Chudzik, Michal Marciniec

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