الفهرس 
History, Epidemiology, pathology,Only 14 pages are availabe for public view
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Abstract
Summary
Multiple sclerosis (MS) is a chronic immune-mediated
disease of the central nervous system resulting in
inflammation, demyelination, and neurodegeneration. Pediatric
MS was defined by the IPMSSG to include ”children” (under
the age of 10) And ”adolescents” (aged 10 and above but prior
to the 18th birthday).
The worldwide prevalence and incidence of pediatric MS
are unknown and the proportion of pediatric MS patients in the
total MS population is unclear. There is available data from
individual countries or MS centers. Demographic
characteristics of pediatric MS show some differences to that
known in adults and varies with age.
More pathological studies are needed as there are few
pathological studies in pediatric MS. Data available shows
some pathological differences between pediatric and adult MS.
Pathology of pediatric MS shows “Plaques”, axonal damage in
NAWM, cortical lesions, meningeal and CSF pathology.
Pathogenesis of the lesions of MS is heterogeneous. It is
generally held that there is a breach in the integrity of the
blood-brain barrier in a person who is genetically predisposed
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Summary
to the disease. It involves multiple immune cells, cytokines
and antibodies. T cells play a key role in the pathophysiology
of MS as activated T cells cross the blood-brain barrier and
incite an inflammatory reaction within the CNS. B cells
differentiate into plasma cells and produce autoantibodies.
Autoantibodies include two crucial types, anti-MOG and
anti-MBP antibodies. Still additional investigations are needed
to further understand the pathogenesis of pediatric MS.
The etiology of MS is complex, it is assumed that both a
complex genetic background and environmental factors and
their interactions contribute to disease manifestation. Genetic
etiology is shown through twins concordance rate, incidence
in relatives and HLA. Environmental etiology include viral
infectious agents such as EBV and HSV, sun exposure and
vitamin D levels, place of residence, smoking (even negative
smoking) and obesity.
Pediatric MS my present with encephalopathy which may
occur with a first episode of MS, seizures, motor and sensory
disturbances that often co-exist, transverse myelitis, brainstem
involvement, cerebellar symptoms and optic neuritis.
Compared to adults with MS, children and adolescents with
MS tend to have polyfocal symptoms, more frequent brainstem
dysfunction and optic neuritis occurrence, more frequent
relapses, a clinical course that is almost universally
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Summary
relapsing-remitting. Younger children with MS differ clinically
from adolescents with MS in clinical features, disease course,
CSF profiles and MRI findings.
Conventional and non-conventional MRI techniques are
used in diagnosis, prognosis and monitoring of treatment
efficacy of pediatric MS. Some differences are found in MRI
features and involved anatomical regions between pediatric
and adult MS patients.
These particularities and differences raise questions about
the ability to use the same diagnostic criteria in the children
and adults with MS, especially in prepubertal patients in whom
the clinical, biological, and radiological presentation seem to
be distinct.
Pediatric MS diagnosis is challenging especially those
who have not yet reached puberty, because of the atypical
clinical, biologic, and MRI presentations and the broader
spectrum of potential differential diagnoses specific to that age
range.
Many efforts were done to have MRI diagnostic and
predictive criteria for pediatric MS diagnosis. The 2010
Revised McDonald criteria are good in older children but less
predictive in younger children. More recently the IPMSSG
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Summary
gave yield to proposed criteria for the diagnosis of pediatric
MS and stated that sensitive and specific MRI criteria for the
youngest patients with MS still need to be developed.
Prognosis of pediatric MS and clinical outcomes include
irreversible disability, fatigue, cognitive impairment and
associated academic consequences, and psychiatric problems.
The initial presentation and symptoms of MS in children
are highly variable, and thus, differential diagnoses include a
wider range of diseases in comparison with adult-onset MS.
They include other demyelinating disorders, systemic
inflammatory disorders, infections, neoplasms,
leukodystrophies, mitochondrial disorders, vascular disorders.
Treatment early in MS disease course appears to have a
greater impact on disease outcome. Acute relapses of pediatric
MS can be treated with methylprednisolone if this is
ineffective, intravenous immunoglobulin or plasmapheresis
may be considered. Disease modifying therapy has been used
for children with pediatric MS to decrease the intensity and
frequency of disease exacerbation. One first-line disease
modifying therapy is used first. If breakthrough disease occurs
or the medication is poorly tolerated, another first-line disease
modifying therapy is used. If the first-line therapies have been
exhausted, second-line therapies may be considered. If this
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Summary
failed combination therapy could be used.
Optimizing quality of life and function can be aided by
the treatment of persistent symptoms. Rehabilitative
techniques, adaptive equipment, and medications can all
contribute. Spasticity, fatigue, tremor, ataxia, cognitive
impairment, bowel and bladder dysfunction and paroxysmal
symptoms can be improved with symptomatic treatment. It is
encouraged for clinicians to consider oral vitamin D
supplementation.