Gadoth Natan
Department of Neurology, Meir General Hospital Kfar-Saba, Kfar-Saba 44281, Israel.
Brain Dev. 2003 Jun;25(4):229-32. doi: 10.1016/s0387-7604(03)00035-4.
Multiple sclerosis (MS) is traditionally the domain of adult neurologists due to its characteristic presentation during early adult life. Although descriptions of infants with MS appeared in the beginning of the last century and the first autopsy was described even earlier, it was not until 1980 that childhood onset MS was recognized and subsequently well characterized. In spite of this, the awareness of pediatricians and pediatric neurologists to the occurrence of MS especially in infants and young children is still unsatisfactory. It is not infrequent that a meticulous, time consuming and costly search for metabolic and degenerative disorders other that MS is initiated before the diagnosis of MS is considered. This leads to a significant diagnostic and therapeutic delay in many young patients. Moreover, when the presentation is acute and characterized by confusion, seizures, CSF pleocytosis following a viral infection, a diagnosis of meningoencephalitis will be frequently reached. In this review, updated data on frequency, epidemiology, some special clinical and radiological features of childhood onset MS, outcome and treatment will be briefly discussed with the purpose of alerting physicians to the possibility of the occurrence of MS even in infants and young children.
传统上，多发性硬化症（MS）是成人神经科医生的诊疗范畴，因为其典型症状出现在成年早期。尽管上世纪初就有关于患MS婴儿的描述，甚至更早之前就有首例尸检报告，但直到1980年儿童期发病的MS才得到确认并随后得到充分描述。尽管如此，儿科医生和儿科神经科医生对MS发病情况，尤其是婴儿和幼儿MS发病情况的认知仍不尽人意。在考虑诊断MS之前，常常会对除MS之外的代谢性和退行性疾病展开细致、耗时且昂贵的排查。这导致许多年轻患者出现显著的诊断和治疗延误。此外，当症状急性发作且表现为意识模糊、癫痫发作、病毒感染后脑脊液淋巴细胞增多时，常常会诊断为脑膜脑炎。在本综述中，将简要讨论儿童期发病MS的发病率、流行病学、一些特殊临床和影像学特征、预后及治疗的最新数据，目的是提醒医生即使在婴儿和幼儿中也可能发生MS。
