Bunyan Reem F, AlAbdulSalam Abdulaziz M, Albarakati Rayan G, Al Harbi Awad A, Alissa Dema A, Al-Jedai Ahmed H, AlKhawajah Nuha M, Al Malik Yaser M, Almejally Mousa A, Al-Mudaiheem Hajer Y, AlNajashi Hind A, AlShehri Amani A, Althubaiti Ibtisam A, AlYafeai Rumaiza H, Babakkor Mohammed A, Cupler Edward J, Ka Mamdouh H, Saeedi Jameelah A, Shosha Eslam, Al Jumah Mohammed A
Department of Neurology, King Fahad Specialist Hospital Dammam, Eastern Region, Saudi Arabia.
Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
Mult Scler Relat Disord. 2022 Oct;66:104061. doi: 10.1016/j.msard.2022.104061. Epub 2022 Jul 17.
Multiple sclerosis (MS) most commonly presents in young adults, although 3-5% of patients develop MS prior to the age of 18 years. The new and comprehensive consensus for the management of MS in Saudi Arabia includes recommendations for the management of MS and other CNS inflammatory demyelinating disorders in pediatric and adolescent patients. This article summarizes the key recommendations for the diagnosis and management of these disorders in young patients. Pediatric and adult populations with MS differ in their presentation and clinical course. Careful differential diagnosis is important to exclude alternative diagnoses such as acute disseminated encephalomyelitis (ADEM) or neuromyelitis optica spectrum disorders (NMOSD). The diagnosis of MS in a pediatric/adolescent patient is based on the 2017 McDonald diagnostic criteria, as in adults, once the possibility of ADEM or NMOSD has been ruled out. Few data are available from randomized trials to support the use of a specific disease-modifying therapy (DMT) in this population. Interferons and glatiramer acetate are preferred initial choices for DMTs based on observational evidence, with the requirement of a switch to a more effective DMT if breakthrough MS activity occurs.
多发性硬化症（MS）最常见于年轻人，不过3%至5%的患者在18岁之前就患上了MS。沙特阿拉伯关于MS管理的新的全面共识包括针对儿科和青少年患者MS及其他中枢神经系统炎性脱髓鞘疾病管理的建议。本文总结了这些疾病在年轻患者中诊断和管理的关键建议。患有MS的儿科和成人人群在表现和临床病程方面存在差异。仔细的鉴别诊断对于排除诸如急性播散性脑脊髓炎（ADEM）或视神经脊髓炎谱系障碍（NMOSD）等其他诊断很重要。儿科/青少年患者的MS诊断基于2017年麦克唐纳诊断标准，与成人一样，一旦排除了ADEM或NMOSD的可能性。随机试验中几乎没有数据支持在该人群中使用特定的疾病修正治疗（DMT）。基于观察证据，干扰素和醋酸格拉替雷是DMT的首选初始选择，如果发生突破性MS活动，则需要改用更有效的DMT。
