Capasso Nicola, Virgilio Eleonora, Covelli Antonio, Giovannini Beatrice, Foschi Matteo, Montini Federico, Nasello Martina, Nilo Annacarmen, Prestipino Elio, Schirò Giuseppe, Sperandei Silvia, Clerico Marinella, Lanzillo Roberta
Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy.
Multiple Sclerosis Unit, Policlinico Federico II University Hospital, Naples, Italy.
Front Neurol. 2023 Jun 2;14:1207617. doi: 10.3389/fneur.2023.1207617. eCollection 2023.
Multiple sclerosis (MS) primarily affects adult females. However, in the last decades, rising incidence and prevalence have been observed for demographic extremes, such as pediatric-onset MS (POMS; occurring before 18 years of age) and late-onset MS (corresponding to an onset above 50 years). These categories show peculiar clinical-pathogenetic characteristics, aging processes and disease courses, therapeutic options, and unmet needs. Nonetheless, several open questions are still pending. POMS patients display an important contribution of multiple genetic and environmental factors such as EBV, while in LOMS, hormonal changes and pollution may represent disease triggers. In both categories, immunosenescence emerges as a pathogenic driver of the disease, particularly for LOMS. In both populations, patient and caregiver engagement are essential from the diagnosis communication to early treatment of disease-modifying therapy (DMTs), which in the elderly population appears more complex and less proven in terms of efficacy and safety. Digital technologies (e.g., exergames and e-training) have recently emerged with promising results, particularly in treating and following motor and cognitive deficits. However, this offer seems more feasible for POMS, being LOMS less familiar with digital technology. In this narrative review, we discuss how the aging process influences the pathogenesis, disease course, and therapeutic options of both POMS and LOMS. Finally, we evaluate the impact of new digital communication tools, which greatly interest the current and future management of POMS and LOMS patients.
多发性硬化症（MS）主要影响成年女性。然而，在过去几十年中，已观察到在人口统计学极端情况下，如儿童期发病的MS（POMS；18岁之前发病）和晚发性MS（发病年龄在50岁以上），发病率和患病率呈上升趋势。这些类别表现出独特的临床发病机制特征、衰老过程和疾病进程、治疗选择以及未满足的需求。尽管如此，仍有几个悬而未决的问题。POMS患者表现出多种遗传和环境因素（如EB病毒）的重要作用，而在晚发性MS中，激素变化和污染可能是疾病的触发因素。在这两类患者中，免疫衰老均成为疾病的致病驱动因素，尤其是对于晚发性MS。在这两类人群中，从疾病诊断沟通到疾病修正治疗（DMTs）的早期治疗，患者和护理人员的参与都至关重要，而在老年人群中，DMTs在疗效和安全性方面似乎更为复杂且证据不足。数字技术（如运动游戏和电子训练）最近已出现并取得了有前景的结果，特别是在治疗和跟踪运动及认知缺陷方面。然而，这种方式对POMS患者似乎更可行，因为晚发性MS患者对数字技术不太熟悉。在这篇叙述性综述中，我们讨论衰老过程如何影响POMS和晚发性MS的发病机制、疾病进程和治疗选择。最后，我们评估新数字通信工具的影响，这些工具对POMS和晚发性MS患者的当前及未来管理具有重大意义。
