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立陶宛儿童多发性硬化症的表现特征。

Characteristics of the Manifestation of Multiple Sclerosis in Children in Lithuania.

机构信息

Department of Neurology, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, 50161 Kaunas, Lithuania.

Department of Neurology, Faculty of Medicine, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania.

出版信息

Medicina (Kaunas). 2023 May 30;59(6):1055. doi: 10.3390/medicina59061055.

Abstract

: Multiple sclerosis (MS) starts quite rarely in childhood, comprising just 3-10% of all diagnosed cases of MS population. The age of onset of the disease may be related to the initial phenotype and the prognosis of MS. The aim of the study is to assess the characteristics of the manifestation of MS in children. : Two groups of patients were analyzed: those diagnosed with MS in childhood (0 < 18 years of age) and who developed MS in 2005-2021, and those diagnosed in adulthood (≥18 years old). The data were collected from the database of the Lithuanian University of Health Sciences Kauno Klinikos. : For the analysis, 105 patients were selected: 35 children (group A) and 70 adults (group B). At the onset of the disease, 62.9% of children and 70.0% of adults experienced visual disturbances ( > 0.05). Isolated symptoms were more common in children (65.7%) as compared to adults (28.6%), < 0.001. Sensory disorders were more common in adults than in children ( < 0.001). Optic nerve and cerebral hemispheres were the most affected in group A ( < 0.05). During the first year after diagnosis, the median number of relapses in group A was higher (3, range 1-5) as compared to group B (1, range 1-2) ( < 0.001). Recovery time after a relapse was shorter in children as compared to adults ( < 0.001). Oligoclonal bands were found in 85.7% of children and in 98.6% of adults. Oligoclonal bands were less common in the childhood-onset than in the adult-onset group ( = 0.007). : The initial symptoms of multiple sclerosis in pediatric patients usually appeared around the age of 16, with a similar frequency in boys and girls, and in most of the childhood cases the initial symptoms were limited to the dysfunction of a single part of the nervous system children usually started with visual disorders, while sensory, coordination and motor disorders were less common. The course of the disease in juvenile patients with MS was more aggressive in the first year as there were more relapses, but the functional impairment recovered faster as compared to adults.

摘要

多发性硬化症(MS)在儿童中很少见,仅占所有 MS 患者的 3-10%。疾病的发病年龄可能与初始表型和 MS 的预后有关。本研究的目的是评估儿童 MS 表现的特征。

分析了两组患者

一组是在儿童时期(0<18 岁)诊断为 MS 并在 2005-2021 年期间发病的患者,另一组是在成年后(≥18 岁)诊断为 MS 的患者。数据是从立陶宛健康科学大学考纳斯临床医院的数据库中收集的。

为了进行分析,共选择了 105 名患者:35 名儿童(A 组)和 70 名成年人(B 组)。在疾病发作时,62.9%的儿童和 70.0%的成年人出现视力障碍(>0.05)。孤立症状在儿童中更为常见(65.7%),而在成年人中则较为少见(28.6%),<0.001。感觉障碍在成年人中比在儿童中更为常见(<0.001)。视神经和大脑半球是 A 组中最常受累的部位(<0.05)。在诊断后的第一年,A 组的中位复发次数更高(3 次,范围 1-5),而 B 组的中位复发次数为 1 次(范围 1-2)(<0.001)。儿童复发后的恢复时间比成年人短(<0.001)。在 85.7%的儿童和 98.6%的成年人中发现了寡克隆带。寡克隆带在儿童发病组比成人发病组少见(=0.007)。

儿科患者多发性硬化症的初始症状通常在 16 岁左右出现,男孩和女孩的发生率相似,大多数儿童病例的初始症状局限于神经系统单一部位的功能障碍,儿童通常以视觉障碍开始,而感觉、协调和运动障碍则较为少见。在发病的第一年,青少年 MS 患者的疾病更为活跃,因为复发更多,但与成年人相比,功能损伤恢复得更快。

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本文引用的文献

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Cognitive Issues in Pediatric Multiple Sclerosis.小儿多发性硬化症中的认知问题
Brain Sci. 2021 Mar 30;11(4):442. doi: 10.3390/brainsci11040442.
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Imaging in Pediatric Multiple Sclerosis : An Iconographic Review.儿童多发性硬化症的影像学:图像综述
Clin Neuroradiol. 2021 Mar;31(1):61-71. doi: 10.1007/s00062-020-00929-8. Epub 2020 Jul 16.
7
Pediatric Multiple Sclerosis: A Review.小儿多发性硬化症:综述
Adv Pediatr. 2019 Aug;66:209-229. doi: 10.1016/j.yapd.2019.03.003. Epub 2019 Apr 20.
8
Pediatric onset multiple sclerosis.儿童发病多发性硬化症。
Rev Neurol (Paris). 2020 Jan-Feb;176(1-2):30-36. doi: 10.1016/j.neurol.2019.02.002. Epub 2019 May 12.
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Paediatric multiple sclerosis: a new era in diagnosis and treatment.儿科多发性硬化症:诊断和治疗的新时代。
Dev Med Child Neurol. 2019 Sep;61(9):1039-1049. doi: 10.1111/dmcn.14212. Epub 2019 Apr 1.
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Management of dysphagia in multiple sclerosis: current best practice.多发性硬化症吞咽困难的管理:当前最佳实践。
Expert Rev Gastroenterol Hepatol. 2019 Jan;13(1):47-54. doi: 10.1080/17474124.2019.1544890. Epub 2018 Nov 15.

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