Ghezzi Angelo
Ospedale di Gallarate, Centro Studi Sclerosi Multipla, via Pastori 4, 21013 Gallarate, Italy.
Expert Rev Neurother. 2005 May;5(3):403-11. doi: 10.1586/14737175.5.3.403.
The characteristics of multiple sclerosis with onset during childhood or adolescence are presented in this review. The clinical findings are similar to those of the adult form, but some aspects are peculiar: the high female to male ratio, occurrence of hyperacute forms, occurrence of encephalopatic symptoms and high relapse rate. The evolution is relapsing-progressive in most cases. Mild and severe disability are reached after a longer interval than in the adult form but, in spite of this, at a given age disability is higher. A high relapse rate, short interval between first and second attack and high disability after the first year are negative prognostic factors. Magnetic resonance imaging and cerebrospinal fluid data are discussed, with particular reference to differential diagnosis from acute disseminated encephalomyelitis. Currently, there are no controlled trials concerning subjects aged under 16 years. Some observations demonstrate that immunomodulatory drugs are well tolerated and have a beneficial effect, reducing the relapse rate and progression of the disease.
本综述介绍了儿童期或青少年期起病的多发性硬化症的特征。临床发现与成人型相似，但有些方面较为特殊：女性与男性比例高、超急性形式的出现、脑病症状的出现以及高复发率。在大多数情况下，病情演变呈复发-进展型。与成人型相比，达到轻度和重度残疾的间隔时间更长，但尽管如此，在特定年龄时残疾程度更高。高复发率、首次发作与第二次发作之间的间隔时间短以及第一年之后的高残疾率都是不良预后因素。文中讨论了磁共振成像和脑脊液数据，特别提及与急性播散性脑脊髓炎的鉴别诊断。目前，尚无针对16岁以下受试者的对照试验。一些观察结果表明，免疫调节药物耐受性良好且具有有益作用，可降低疾病的复发率和进展。
