Therapeutic Approach to the Management of Pediatric Demyelinating Disease: Multiple Sclerosis and Acute Disseminated Encephalomyelitis

Abstract

Acquired pediatric demyelinating diseases manifest acutely with optic neuritis, transverse myelitis, acute disseminated encephalomyelitis, or with various other acute deficits in focal or polyfocal areas of the central nervous system. Patients may experience a monophasic illness (as in the case of acute disseminated encephalomyelitis) or one that may manifest as a chronic, relapsing disease [e.g., multiple sclerosis (MS)]. The diagnosis of pediatric MS and other demyelinating disorders of childhood has been facilitated by consensus statements regarding diagnostic definitions. Treatment of pediatric MS has been modeled after data obtained from clinical trials in adult-onset MS. There are now an increasing number of new therapeutic agents for MS, and many will be formally studied for use in pediatric patients. There are important efficacy and safety concerns regarding the use of these therapies in children and young adults. This review will discuss acute management as well as chronic immunotherapies in acquired pediatric demyelination.

Standardised guidelines and reference networks for treating neuroinflammatory conditions in children are lacking

“…Early and aggressive immune therapy improves outcome and failure to recognise an inflammatory condition and initiate appropriate treatment may lead to detrimental outcome and even death. Whereas guidelines are available for some diagnoses, there is a paucity of guidelines for others, such as encephalitis in general .…”

Characterization of variations in IL23A and IL23R genes: possible roles in multiple sclerosis and other neuroinflammatory demyelinating diseases

“…The reasons underlying those differences between MS and other demyelinating syndromes may be in the balance status of effectors and regulatory immune cells, immune activation, and age-related immune cell access into the central nervous system [25]. …”

Pediatric Multiple Sclerosis

“…Side effects include fever, headache, aseptic meningitis, thromboembolism, and allergic reactions. Severe allergic reactions may develop in people with IgA deficiency; therefore, serum IgA levels should be examined before treatment [42,43].…”

“…Standard dosage is 20 mg daily by subcutaneous injection. Its side effects include injection reactions, lipoatrophy at injection sites, chest pain, and a post-injection reaction (anxiety, flushing, palpitations, dyspnea, and chest pain) [42][43][44].…”