Chabas Dorothée, Green Ari J, Waubant Emmanuelle
University of California at San Francisco, Multiple Sclerosis Center, 94117, USA.
NeuroRx. 2006 Apr;3(2):264-75. doi: 10.1016/j.nurx.2006.01.011.
Multiple sclerosis (MS) occurs at all ages of the pediatric population. Childhood MS may represent up to 10% of all MS cases. Establishing the diagnosis of MS in a child is complicated by the limited diagnostic criteria and the possibility of significant clinical and magnetic resonance imaging (MRI) overlap with acute disseminated encephalomyelitis and other pediatric diseases. Although the clinical profile of MS appears similar to that seen in adults, several features may differ and specific issues arise in children. Sex ratios are different between young children with MS and adolescents--implicating a role for sex hormones in disease pathogenesis and/or modification of disease expression. Younger patients with MS are more likely to have seizures, brainstem, and cerebellar symptoms than adults. Children with MS may have fewer T2 hyperintense areas on MRI scans, therefore not meeting MRI criteria established for adults. It is possible that the pediatric MS course is more indolent than in adult patients but the disease may lead to significant disability at a younger age, e.g., while patients are students, young professionals, or want to start a family. There has been no controlled clinical trial in children with disease modifying therapies approved for adult MS due to the limited number of patients under the age of 18 years compared with the adult contingent. As a result, children are receiving adult therapies in an arbitrary manner and our understanding of pediatric treatment effect and tolerability is limited. Available data on tolerability of approved drugs for adults is reviewed.
多发性硬化症（MS）可发生于儿科人群的各个年龄段。儿童期MS可能占所有MS病例的10%。由于诊断标准有限，且在临床和磁共振成像（MRI）方面可能与急性播散性脑脊髓炎及其他儿科疾病存在显著重叠，因此儿童MS的诊断较为复杂。尽管MS的临床特征与成人相似，但仍有一些特征可能不同，且儿童还会出现一些特定问题。MS患儿与青少年的性别比例不同，这表明性激素在疾病发病机制和/或疾病表现的改变中发挥了作用。与成人相比，MS患儿更易出现癫痫发作、脑干和小脑症状。MS患儿在MRI扫描上的T2高信号区域可能较少，因此不符合为成人制定的MRI标准。小儿MS病程可能比成人患者更为隐匿，但该病可能在患者年龄较小时导致严重残疾，例如在患者还是学生、年轻专业人员或想要组建家庭时。由于18岁以下患者数量与成人患者相比有限，因此尚未对批准用于成人MS的疾病修饰疗法在儿童中进行对照临床试验。结果，儿童正在以一种随意的方式接受成人疗法，而我们对儿科治疗效果和耐受性的了解有限。本文对已批准用于成人的药物的耐受性现有数据进行了综述。
