Pediatric multiple sclerosis: pathogenesis, clinical and radiological features, diagnosis and treatment

Abstract

Data on the epidemiology, clinical features, diagnosis and treatment of paediatric multiple sclerosis (PMS), as well as characteristics of the immune and endocrine status of children compared with the population with multiple sclerosis (MS) were analysed using the Scopus, Web of Science, MedLine, The Cochrane, EMBASE, Global Health and RSCI databases. The MS course in children and adults has a number of important differences, which may require the development of different treatment approaches than in adults. At the same time, despite the large number of studies on PMS, the pathogenesis of these above differences remains unclear. PMS is characterised by a more active course than in the adult population and by greater severity of exacerbations; in addition, a more rapid increase in lesion volume and early brain atrophy are observed in the absence of effective treatment. Despite a more rapid and complete regression of the neurological deficit after exacerbations and, consequently, a slower rate of its accumulation, conversion to SPMS and achievement of disability occurs at an earlier age. The characteristics of subsets and functional differences of lymphocytes revealed by immunological studies suggest possible differences in the choice of disease-modifying therapies in children and adults. However, the number of studies on the immune and endocrine status of patients with PMS compared with the adult population is limited and the results are often conflicting. PMS is therefore an important medical and social problem that requires further research to optimise approaches to disease-modifying therapies.