Multiple Sclerosis and other Demyelianting Diseases. MT 6.3
“Special issues in pediatric multiple sclerosis”
Silvia Tenembaum
The recently published revised diagnostic criteria enable the differentiation of MS, acute disseminated encephalomyelitis (ADEM), neuromyelitis optica (NMO), and other immune mediated inflammatory disorders of the CNS. Nevertheless, MS diagnosis in childhood is still challenging, even using rigorous inclusion criteria and standardized definitions. In addition, advances in diagnostic biomarkers may prove to be useful in the future.
Environmental factors associated with pediatric MS risk and possibly outcomes include vitamin D deficiency, extreme obesity, second hand smoking, and EBV infection.
Regarding MS outcomes, our understanding of the cognitive consequences of early onset MS has grown. However, further work is needed to redefine the course of cognitive function and to develop strategies for effective cognitive rehabilitation specifically tailored to children and adolescents.
Finally, treatment strategies for pediatric patients with MS need to be discussed. There is only limited approval for beta-interferons and glatiramer acetate use in pediatric patients over the age of 11 by the EMA, although safety data for beta-IFN-1a tiw for children older than 2 years of age is included in the European label. Considering that there have been significant advances in MS therapeutics for adult patients, clinical trials of newer MS agents in children are required to bring information regarding the efficacy and safety of newer drugs.
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© 2015 Published by Elsevier Inc.
