Treatment in childhood central nervous system demyelinating disorders

Abstract

The last two decades witnessed significant advances in the treatment of acquired demyelinating disorders: thirteen new agents have been approved for the treatment of multiple sclerosis in adults by the European Medicines Agency and US Food and Drug Administration in the last twenty years. Although the long‐term efficacy and safety profiles of some new drugs are still being assessed in paediatric MS, clinicians may have to use them in the management of paediatric onset MS resistant to first‐line medications, based on results obtained in adult‐onset disease. This review summarizes the current approach to treatment in children with demyelinating syndromes. What this paper adds Serological markers affect management in paediatric demyelinating diseases. Antibodies against aquaporin‐4 and myelin oligodendrocyte glycoprotein should be tested in children with acute demyelinating disease. New therapeutic agents currently in trial for pediatric disease should be used with close follow‐up.

Treatment of MOG-IgG associated disease in paediatric patients: A systematic review

“…We observed that most studies reported the use of IVIG over PLEX, but this might be due to the lack of availability of PLEX in several centres. One controversial topic is the oral corticosteroids tapering, as some experts suggest that the oral steroid tapering could prevent early relapses (Hennes et al, 2018;Konuskan and Anlar 2019) and others have concerns about a possible iatrogenic effect of steroid taper increasing the number of relapses by adrenal suppression especially in young children. Hacohen and Banwell (2019) There is no consensus regarding the use and type of the long-term maintenance treatment.…”

“…Subsequent review articles advocated for immunosuppressive therapies, such as mycophenolate mofetil, azathioprine, and anti-CD20 B-cell depleting therapies. Dale et al (2012) Konuskan and Anlar (2019) recommended mycophenolate mofetil or azathioprine as first line medications associated with low dose steroids or monthly IVIG until full efficacy and RTX or cyclophosphamide for severe or refractory cases. Hennes et al (2018) suggested that RTX and IVIG should be the initial choices.…”

Narrative review based on fingolimod therapy in pediatric MS

“…Only fingolimod and teriflunomide are approved in Europe for children. [33][34][35][36][37][38] Teriflunomide, fingolimod, dimethyl fumarate, rituximab, natalizumab, ocrelizumab, and alemtuzumab are used as primary/secondary or tertiary care in different positions in each country. Individualized treatment should also be considered in the POMS group.…”