Zusammenfassung
Die Multiple Sklerose (MS) ist eine chronisch-entzündliche, demyelinisierende Erkrankung des zentralen Nervensystems ungeklärter Genese. Sie betrifft überwiegend junge Erwachsene, aber in 3–5% der Fälle auch Kinder und Jugendliche vor dem 16. Geburtstag. Häufige Symptome bei Kindern sind visuelle Störungen, Sensibilitätsausfälle und motorisch-koordinative Symptome. Der Krankheitsverlauf ist meist schubförmig-remittierend, häufig mit Komplettremission, in seltenen Fällen auch primär chronisch progredient. Typische paraklinische Befunde sind Läsionen der weißen Hirnsubstanz, oligoklonale Banden im Liquor und verzögerte evozierte Potenziale. Die akuten Schübe können mit Methylprednisolonstößen behandelt werden. Als Langzeitbehandlung kommen schubprophylaktische, immunmodulatorische Therapien zur Anwendung.
Abstract
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disorder of the central nervous system of unknown etiology normally affecting young adults. Approximately 3–5% of MS patients have onset before the age of 16 (pediatric MS). Neurological deficiencies can occur in multifocal localisations. McDonald’s criteria include the dissemination in space and time of the disease activity. Symptoms include, for example, visual dysfunction and sensory or motor impairments. The most frequent clinical manifestation in the pediatric group is a relapsing-remitting disease course, with a milder course of disease and a lower rate of progression when compared to adult MS. Typical diagnostic findings are periventricular lesions of the white matter, oligoclonal bands in the cerebrospinal fluid and delayed evoked potentials. Relapses are treated with high-dose methylprednisolone. Prophylactic, immunomodulative therapies as suggested for adult MS patients are also used for children.
Literatur
Banwell B, Ghezzi A, Bar-or A et al (2007) Multiple sclerosis in children: clinical diagnosis, therapeutic strategies and future directions. Lancet Neurol 6:887–902
Boiko A, Vorobeychik G, Paty D et al (2002) Early onset multiple sclerosis: a longitudinal study. Neurology 59:1006–1010
Deryck O, Ketelaer P, Dubois B (2006) Clinical characteristics and long term prognosis in early onset multiple sclerosis. J Neurol 253:720–723
Duquette P, Murray Tj, Pleines J et al (1987) Multiple sclerosis in childhood: clinical profile in 125 patients. J Pediatr 111:359–363
Ghezzi A, Pozzilli C, Liguori M et al (2002) Prospective study of multiple sclerosis with early onset. Mult Scler 8:115–118
Ghezzi A, Amato Mp, Capobianco M et al (2005) Disease-modifying drugs in childhood-juvenile multiple sclerosis: results of an Italian co-operative study. Mult Scler 11:420–424
Huppke P, Stark W, Zürcher C et al (2008) Natalizumab use in pediatric multiple sclerosis. Arch Neurol 65(12):1655–1658
Krone B, Pohl D, Rostasy K et al (2008) Common infectious agents in multiple sclerosis: a case-control study in children. Mult Scler 14:136–139
Krupp LB, Banwell B, Tenembaum S (2007) Consensus definitions proposed for pediatric multiple sclerosis and related disorders. Neurology 68:S7–S12
Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33:1444–1452
Mikaeloff Y, Suissa S, Vallee L et al (2004) First episode of acute CNS inflammatory demyelination in childhood: prognostic factors for multiple sclerosis and disability. J Pediatr 144:246–252
Mikaeloff Y, Caridade G, Suissa S et al (2008) Hepatitis B vaccine and the risk of CNS inflammatory demyelination in childhood. Neurology Oct 8. [Epub ahead of print]
Ness JM, Chabas D, Sadovnick AD et al (2007) Clinical features of children and adolescents with multiple sclerosis. Neurology 68:S37–S45
Ozakbas S, Idiman E, Baklan B et al (2003) Childhood and juvenile onset multiple sclerosis: clinical and paraclinical features. Brain Dev 25:233–236
Pohl D, Rostasy K, Gärtner J et al (2005) Treatment of early onset multiple sclerosis with subcutaneous interferon beta-1a. Neurology 64:888–890
Pohl D, Hennemuth I, Von Kries R et al (2007) Paediatric multiple sclerosis and acute disseminated encephalomyelitis in Germany: results of a nationwide survey. Eur J Pediatr 166:405–412
Polman CH, Reingold SC, Edan G et al (2005) Diagnostic criteria for multiple sclerosis: 2005 revisions to the „McDonald Criteria“. Ann Neurol 58:840–846
Renoux C, Vukusic S, Mikaeloff Y et al (2007) Natural history of multiple sclerosis with childhood onset. N Engl J Med 356:2603–2613
Rieckmann P (2006) Escalating immunomodulatory therapy of multiple sclerosis. Update (September 2006). Nervenarzt 77:1506–1518
Simone Il, Carrara D, Tortorella C et al (2002) Course and prognosis in early-onset MS: comparison with adult-onset forms. Neurology 59:1922–1928
Sindern E, Haas J, Stark E et al (1992) Early onset MS under the age of 16: clinical and paraclinical features. Acta Neurol Scand 86:280–284
Tenembaum S, Chitnis T, Ness J et al (2007) Acute disseminated encephalomyelitis. Neurology 68:S23–S36
Weinshenker BG, Bass B, Rice GP et al (1989) The natural history of multiple sclerosis: a geographically based study. I. Clinical course and disability. Brain 112(Pt 1):133–146
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Stark, W., Gärtner, J. Multiple Sklerose (Enzephalomyelitis disseminata) des Kindes- und Jugendalters. Monatsschr Kinderheilkd 157, 67–80 (2009). https://doi.org/10.1007/s00112-008-1915-4
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DOI: https://doi.org/10.1007/s00112-008-1915-4
Schlüsselwörter
- Multiple Sklerose
- Pädiatrische MS
- McDonald-Kriterien
- Klinisch isoliertes Syndrom
- Immunmodulatorische Therapie