Pediatria pre prax 2/2022

New trends in MS treatment in children

Multiple sclerosis (MS) is the most common chronic inflammatory autoimmune neurodegenerative CNS disease. It occurs mainly in the population of young adults from 20 to 50 years. In 2 – 5 % of all cases it occurs before the age of 18, in 1 – 3 % before the age of 10. In the pediatric population, the disease is characterized by its high inflammatory activity. This is reflected in a higher annual relapse rate (ARR), which lasts even after reaching adulthood. In MRI, there are more extensive inflammatory lesions in both the white and gray matter of the brain, with a significant loss of axons. The degenerative component of the disease is present in the early stages of the disease, followed by global brain atrophy in the MRI image. Although children have greater cognitive and functional reserve, they are capable of partial remyelination, recover more rapidly from the onset of the disease, and rarely have a permanent deficit during the first years. They are achieving worse scores compared to AOMS (adult-onset MS) in functional (EDSS – expanded disability status scale) and cognitive tests in adulthood. Therefore, we consider POMS (pediatric onset multiple sclerosis) to be a serious, potentially debilitating disease, with serious socio-economic impacts on patients.

Keywords: demyelinating syndromes in pediatrics, pediatric-onset multiple sclerosis, new trends of treatment, children