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2018 ; 18
(1
): 27
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Pediatric multiple sclerosis: a review
#MMPMID29523094
Alroughani R
; Boyko A
BMC Neurol
2018[Mar]; 18
(1
): 27
PMID29523094
show ga
BACKGROUND: Pediatric-onset multiple sclerosis (POMS) prevalence and incidence
rates are increasing globally. No disease-modifying therapy are approved for MS
pediatric population. Hence, we aim to review the literature on POMS to guide
treating physicians on the current understanding of diagnosis and management of
pediatric MS. METHODS: The authors performed a literature search and reviewed the
current understanding on risk factors and disease parameters in order to discuss
the challenges in assessing and implementing diagnosis and therapy in clinical
practice. RESULTS: The revised International Pediatric MS group diagnostic
criteria improved the accuracy of diagnosis. Identification of red flags and
mimickers (e.g. acute disseminated encephalomyelitis and neuromyelitis optica)
are vital before establishing a definitive diagnosis. Possible etiology and
mechanisms including both environmental and genetic risk factors are highlighted.
Pediatric MS patients tend to have active inflammatory disease course with a
tendency to have brainstem / cerebellar presentations at onset. Due to efficient
repair mechanisms at early life, pediatric MS patients tend to have longer time
to reach EDSS 6 but reach it at earlier age. Although no therapeutic randomized
clinical trials were conducted in pediatric cohorts, open-label multi-center
studies reported efficacy and safety results with beta interferons, glatiramer
acetate and natalizumab in similar adult cohorts. Several randomized clinical
trials assessing the efficacy and safety of oral disease-modifying therapies are
ongoing in pediatric MS patients. CONCLUSION: Pediatric MS has been increasingly
recognized to have a more inflammatory course with frequent infratentorial
presentations at onset, which would have important implications in the future
management of pediatric cohorts while awaiting the results of ongoing clinical
trials.
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