Bigi Sandra, Banwell Brenda
Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
J Child Neurol. 2012 Nov;27(11):1378-83. doi: 10.1177/0883073812452784. Epub 2012 Aug 21.
Pediatric multiple sclerosis has been increasingly recognized in the past 10 to 15 years; 3% to 5% of all multiple sclerosis patients experience their first attack in childhood. Childhood multiple sclerosis has a relapsing-remitting disease course. The first attack, or "acquired demyelinating syndrome," consists of optic neuritis, transverse myelitis, acute disseminated encephalomyelitis, and monofocal or polyfocal neurological deficits. The diagnosis of multiple sclerosis necessitates the clinical or magnetic resonance imaging confirmation of dissemination in space and time and exclusion of other disorders. The morbidity of childhood multiple sclerosis is significant; within the first 2 years from onset, 30% of children have significant cognitive impairment, 50% show signs of depression, and 75% are fatigued. The relapse rate in children with multiple sclerosis is higher than in adult-onset disease. Following acute treatment, recovery after the first attacks is usually excellent, but patients with childhood-onset multiple sclerosis reach permanent disability or enter the secondary progressive disease course 10 years younger than patients with adult-onset multiple sclerosis.
在过去10到15年里，儿童多发性硬化症越来越受到关注；所有多发性硬化症患者中有3%至5%在儿童期首次发病。儿童多发性硬化症呈复发-缓解型病程。首次发作，即“获得性脱髓鞘综合征”，包括视神经炎、横贯性脊髓炎、急性播散性脑脊髓炎以及单灶性或多灶性神经功能缺损。多发性硬化症的诊断需要通过临床或磁共振成像确认病变在空间和时间上的播散，并排除其他疾病。儿童多发性硬化症的发病率很高；在发病后的头两年内，30%的儿童有明显的认知障碍，50%表现出抑郁症状，75%感到疲劳。儿童多发性硬化症患者的复发率高于成人发病型疾病。经过急性治疗后，首次发作后的恢复通常很好，但儿童期发病的多发性硬化症患者比成人发病的患者早10年达到永久性残疾或进入继发进展型病程。
