Multipl Skleroz
Özet
Pediatrik Multipl Skleroz (PedMS), merkezi sinir sisteminde enflamasyon ve akson hasarı ile karakterize, erişkin formlardan daha yüksek inflamatuar aktivite gösteren kronik bir otoimmün hastalıktır. Hastalık patogenezinde genetik yatkınlığın yanı sıra obezite, EBV enfeksiyonları ve D vitamini düzeyi gibi çevresel faktörler kritik rol oynamaktadır. Tanı süreci, çocukluk çağına özgü ayırıcı tanıları içeren özel kriterlere dayanmakta olup, yanlış teşhisi önlemek adına dikkatli bir klinik değerlendirme gerektirir. Tedavi stratejileri, atak oranlarını minimize etmek ve uzun vadeli özürlülüğü engellemek amacıyla, her çocuğun klinik tablosuna uygun, yeni nesil immünomodülatör yaklaşımları içermektedir.
Pediatric Multiple Sclerosis (PedMS) is a chronic autoimmune disease characterized by central nervous system inflammation and axonal damage, which exhibits higher inflammatory activity and distinct clinical features compared to adult-onset forms. Pathogenesis is driven by complex interactions between genetic predisposition and environmental factors such as obesity, Epstein-Barr virus exposure, and vitamin D deficiency. Diagnosis necessitates the use of specialized pediatric criteria to accurately distinguish the condition from other childhood-onset demyelinating disorders. Management strategies focus on implementing individualized, high-efficacy immunomodulatory therapies to effectively mitigate relapse rates and prevent long-term disability in pediatric patients.
Referanslar
Padilha GI, Fonseca APA, Pettengill ALM, et al. Pediatric multiple sclerosis: from clinical basis to imaging spectrum and differential diagnosis. Pediatr Radiol. 2020;50(6):776-792.
Wang, CX, Greenberg BM. Pediatric Multiple Sclerosis: From Recognition to Practical Clinical Management. Neurol Clin. 2018,36,135–149.
Vasileiadis GK, Dardiotis E, Mavropoulos A et al. Regulatory B and T lymphocytes in multiple sclerosis: friends or foes? Auto Immun Highlights. 2018;9(1):9.
Langille MM, Rutatangwa A, Francisco C. Pediatric Multiple Sclerosis: A Review. Adv Pediatr. 2019;66:209-229.
Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A. Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis. JAMA. 2006;296:2832-2838.
Banwell B, Krupp L, Kennedy J, et al. Clinical features and viral serologies in children with multiple sclerosis: a multinational observational study. Lancet Neurol. 2007;6:773-781.
Makhani N, Banwell B, Tellier R, et al. Viral exposures and MS outcome in a prospective cohort of children with acquired demyelination. Mult Scler. 2016;22:385-388.
Huppke B, Ellenberger D, Hummel H, et al. Association of Obesity with Multiple Sclerosis Risk and Response to First-line Disease Modifying Drugs in Children. JAMA Neurol. 2019,76,1157–1165.
Nielsen NM,Westergaard T, Rostgaard K, et al. Familial risk of multiple sclerosis: a nationwide cohort study. Am J Epidemiol. 2005;162(8):774–8.
Gianfrancesco MA, Stridh P, Shao X, et al. Genetic risk factors for pediatric-onset multiple sclerosis. Mult Scler. 2018;24(14):1825-1834.
Absoud M, Lim MJ, Chong WK, et al. Paediatric acquired demyelinating syndromes: incidence, clinical and magnetic resonance imaging features. Mult Scler. 2013;19:76–86.
Mikaeloff Y, Caridade G, Assi S, Suissa S, Tardieu M. Prognostic factors for early severity in a childhood multiple sclerosis cohort. Pediatrics. 2006;118:1133–9.
Hacohen Y, Mankad K, Chong WK, et al. Diagnostic algorithm for relapsing acquired demyelinating syndromes in children. Neurology. 2017;89:269–78.
Gorman MP, Healy BC, Turcsany PM, Chitnis T. Increased relapse rate in pediatric-onset compared with adult-onset multiple sclerosis. Arch Neurol. 2009,66,54–59.
Thompson AJ, Banwell BL, Barkhof F, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018,17,162–173.
Krupp LB, Tardieu M, Amato MP et al. International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: revisions to the 2007 definitions. Mult Scler. 2013;19: 1261–1267.
Hacohen Y, Brownlee W, Mankad K, et al. Improved performance of the 2017 McDonald criteria for diagnosis of multiple sclerosis in children in a real-life cohort. Mult Scler. 2020;26(11):1372-1380.
Toğrol RE, Demir S, Tütüncü M, Demirkaya Ş, Koçer B. Multipl skleroz tanı ve izleminde manyetik rezonans inceleme ilkeleri. Efendi H, Kuşçu DM, editörler. Multipl Skleroz tanı ve tedavi klavuzu 2018. 1. Baskı. İstanbul: Galenos Yayınevi; 2018.p.29-49.
Pohl D, Rostasy K, Reiber H, Hanefeld F. CSF characteristics in early-onset multiple sclerosis. Neurology. 2004;63:1966–7.
Riikonen R, Ketonen L, Sipponen J. Magnetic resonance imaging, evoked responses and cerebrospinal fluid findings in a follow-up study of children with optic neuritis. Acta Neurol Scand. 1988;77:44–49.
Ghezzi A, Pozzilli C, Liguori M, et al. Prospective study of multiple sclerosis with early onset. Mult Scler. 2002;8:115–118.
Wong YYM, van der Vuurst de Vries RM, van Pelt ED, et al. T-cell activation marker sCD27 is associated with clinically definite multiple sclerosis in childhood-acquired demyelinating syndromes. Mult Scler. 2018;24:1715–24.
Reinert M-C BC, Michalak Z, Bruck W, Huppke P, et al. Neurofilament light chain is a useful biomarker in paediatric multiple sclerosis. ECTRIMS. Berlin 2018
Fisher KS, Cuascut FX, Rivera VM, Hutton GJ. Current Advances in Pediatric Onset Multiple Sclerosis Biomedicines. 2020;8(4):71.
Waldman A, Ghezzi A, Bar-Or A, Mikaeloff Y, Tardieu M, Banwell B. Multiple sclerosis in children: an update on clinical diagnosis, therapeutic strategies, and research. Lancet Neurol. 2014;13:936–48.
Iaffaldano P, Simone M, Lucisano G, et al. Prognostic indicators in pediatric clinically isolated syndrome. Ann Neurol. 2017,81,729–39.
Banwell B, Bar-Or A, Arnold DL, et al. Clinical, environmental, and genetic determinants of multiple sclerosis in children with acute demyelination: a prospective national cohort study. Lancet Neurol. 2011;10:436–45.
Lucchinetti CF, Kiers L, O’Du y A, et al. Risk factors for developing multiple sclerosis after childhood optic neuritis. Neurology. 1997,49,1413–18.
Absoud M, Greenberg BM, Lim M, Lotze T, Thomas T, Deiva K. Pediatric transverse myelitis. Neurology. 2016;87:46–52.
Chitnis T, Tenembaum S, Banwell B et al. Consensus statement: evaluation of new and existing therapeutics for pediatricmultiple sclerosis. Mult Scler. 2012;18:116–127.
Wassmer E, Chitnis T, Pohl D, et al. International PediatricMS Study Group Global Members Symposium report. Neurology. 2016;87(9):S110–6.
Krysko KM, Graves J, Rensel M, et al. Use of newer diseasemodifying therapies in pediatric multiple sclerosis in the US. Neurology. 2018;91(19):e1778–87.
Zhang J, Hutton G, Zang Y. A comparison of the mechanisms of action of interferon beta and glatiramer acetate in the treatment of multiple sclerosis. Clin Ther. 2002;24:1998–2021.
Aharoni R. The mechanism of action of glatiramer acetate in multiple sclerosis and beyond. Autoimmun Rev. 2013;12:543–53.
Chitnis T, Banwell B, Arnold D, et al. Teriflunomide efficacy and safety in pediatric patients with relapsing forms of MS: interim analysis of the open-label TERIKIDS trial extension. ECTRIMS. Virtual (2020).
Alroughani R, Huppke P, Mazurkiewicz-Beldzinska M, et al. Delayed-Release Dimethyl Fumarate Safety and Efficacy in Pediatric Patients With Relapsing-Remitting Multiple Sclerosis. Front Neurol. 2021;4(11):606418.
Chitnis T, Arnold DL, Banwell B, et al. PARADIGMS Study Group Trial of Fingolimod versus Interferon Beta-1a in Pediatric Multiple Sclerosis. N Engl J Med. 2018;379(11):1017-1027.
Margoni M, Rinaldi F, Riccardi A, Franciotta S, Perini P, Gallo P. No evidence of disease activity including cognition (NEDA-3 plus) in naive pediatric multiple sclerosis patients treated with natalizumab. J Neurol. 2020;267:100–5.
Burman J, Kirgizov K, Carlson K, et al. Autologous hematopoietic stem cell transplantation for pediatric multiple sclerosis: a registry-based study of the Autoimmune Diseases Working Party (ADWP) and Pediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplant. 2017;52:1133–7.
Huppke P, Huppke B, Ellenberger D, et al. Therapy of highly active pediatric multiple sclerosis. Mult Scler. 2017;25:72–80.
Renoux C, Vukusic S, Mikaeloff Y, et al. Natural history of multiple sclerosis with childhood onset. N Engl J Med. 2007;356:2603–13.
Langille ML, Rutatangwa A, Francisco C. Multiple Sclerosis: A Review. Adv Pediatr Pediatric. 2019;66:209-229.
Amato MP, Krupp LB, Charvet LE, Penner I, Till C. Pediatric multiple sclerosis cognition and mood. Neurology. 2016;87(9):82–7.
Mikaeloff Y, Caridade G, Assi S, Suissa S, Tardieu M. Prognostic factors for early severity in a childhood multiple sclerosis cohort. Pediatrics. 2006;118:1133–9.
K Deiva. Pediatric onset multiple sclerosis. Rev Neurol. 2020;176(1-2):30-6.
A Ruet. Update on pediatric-onset multiple sclerosis. Rev Neurol. 2018;174(6):398-407.
