Treatment of multiple sclerosis in children and its challenges

Narula, Sona; Banwell, Brenda

doi:10.1016/j.lpm.2014.10.018

Cited by 7 publications

(3 citation statements)

References 51 publications

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“…A RRMS form was diagnosed in all patients of our series, which is in agreement with literature, where RRMS form is higher than 80% in the pediatric population [ 3 , 12 , 13 ]. After the use of modifying therapy, only one patient developed a secondary progressive form.…”

Section: Discussionsupporting

confidence: 92%

Pediatric Multiple Sclerosis in Tunisia: A Retrospective Study over 11 Years

Achour

Rebai

Raddadi

et al. 2017

BioMed Research International

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Introduction Pediatric multiple sclerosis (pMS) is a rare demyelinating disorder with an onset before the age of 18 years. In this study, we aimed to investigate the characteristics of pMS in Tunisian children. Patients and Methods We conducted a retrospective study over 11 years (2005–2016) including all patients diagnosed with pMS according to the International Pediatric Multiple Sclerosis Study Group (IPMSSG) criteria of 2012 and followed up in a tertiary care research center. Epidemiological, clinical, neuroimaging, laboratory, and therapeutic data were collected and analyzed. Results There were 21 patients. The male-female ratio was 1 : 3. Mean age at onset was 11 years (range: 3–17 years). Three patients had type 1 diabetes. Polyfocal presentation was preponderant (81%) with motor dysfunction in 57% of patients. Paroxysmal dystonia was noticed in 24%. All patients were diagnosed with relapsing-remitting form. Interferon beta was prescribed in 80% with a reduction of annual relapse rate. Conclusion The annual incidence of pMS in Tunisian children aged below 18 years could be estimated as 0.05 per 100,000. Singular features in our cohort were the frequent association with type 1 diabetes and the increased occurrence of dystonia. Greater awareness of pMS may be helpful to improve management strategies of children and their families.

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Section: Discussionsupporting

confidence: 92%

Pediatric Multiple Sclerosis in Tunisia: A Retrospective Study over 11 Years

Achour

Rebai

Raddadi

et al. 2017

BioMed Research International

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“…To limit long-term disability, disease-modifying therapy should be initiated as soon as diagnosis is confirmed. First-line disease-modifying therapies for use in pediatric MS are glatiramer acetate and IFN-β-1a and -1b [35]. A significant proportion of patients will need to transition from first-to second-line therapy within the first few years after diagnosis due to inadequate response or poor tolerance [36].…”

Section: Management Of Pediatric Msmentioning

confidence: 99%

Movement Disorders in Multiple Sclerosis and Their Treatment

Deuschl

2016

Neurodegener. Dis. Manag.

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Hyperkinetic movement disorders such as tremors are not uncommon in patients with multiple sclerosis (MS). The classical feature is intention tremor, whereas rest tremors appear not to occur. Treatment is mainly invasive, with options of Gamma Knife surgery, thalamotomy or deep brain stimulation depending on individual circumstances. Deep brain stimulation is the only option for patients who require a bilateral intervention. All treatment recommendations have only low evidence. Tremors can also be cured spontaneously by a subsequent strategic MS lesion. Paroxysmal dyskinesias are rarer than tremors. The rarest MS movement disorder is symptomatic paroxysmal choreoathetosis, tonic spasms or 'brain stem fits'; attacks are short but frequent, up to 200 per day and generally respond well to carbamazepine.

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“…84 Pediatric MS is defined based on the 2010 McDonald criteria: 2 typical MS attacks, affecting the brain, spinal cord and optic nerve with one month interval; a first clinical event with involvement of at least 2 of MS-specific sites in MRI (periventricular, juxtacortical, infratentorial, or spinal cord) and dissemination in time (clinically-silent enhancing or non-enhancing on T1-weighted images); one attack of ADEM followed by a second none-ADEM event after 3 months; one typical MS event (without encephalopathy) and MRI demonstrating at least one new T2 lesion on a scan more than 30 d after the attack. 85 The first attack of MS is also known as clinically isolated syndrome (CIS). MRI is used for diagnosis of MS and is considered positive when 3 of these 4 criteria are positive: 9 white matter lesions, 3 periventricular lesions, 1 juxtacortical lesion and one infratentorial lesion.…”

Section: Pediatric Multiple Sclerosis (Ms) Immunopathogenesis and Thmentioning

confidence: 99%