In most cases it affects young people between the ages of 20 and 40, but multiple sclerosis does not spare children and adolescents. According to the Italian Multiple Sclerosis Association (Aism) the disease onset in pediatric age in 5-10% of total cases. There are two forms of pediatric multiple sclerosis: ‘infantile’, which occurs before 12 years of age, e ‘adolescent’ which makes its appearance between the ages of 12 and 18. “The risk of disease onset is higher during puberty, while it is very rare under 10 years of age. Fortunately, thanks to so-called ‘modifying’ drugs, the expectation of multiple sclerosis patients, both children and adults, in terms of quality of life is absolutely good today. We have the possibility to stop the disease ”. So Massimiliano Valeriani, head of the Multiple Sclerosis Center of the Bambino Gesù Pediatric Hospital in Rome in an interview published on the ‘Aleati per la Salute’ website (www.alleatiperlasalute.it).
On ‘Allies for Health’, a portal dedicated to medical-scientific information created by Novartis Italy, the expert takes stock of new drugs for the treatment of multiple sclerosis in pediatric age, a disease that appears with different symptoms, depending on the affected regions of the brain or spinal cord. The most frequent are: sensory and motor disturbances, vision disturbances (double vision) or walking.
“In the child – remembers Valeriani – also particular symptoms such as sleepiness, headache, seizures or cognitive disturbances may be present which make diagnosis more difficult, since they are similar to the symptoms that characterize another children’s disease, namely acute disseminated encephalomyelitis ”.
The clinical manifestations are quite heterogeneous. “For example, there may be – continues Valeriani – acute squint or facial paresis. Quite common is the onset with loss of vision in one eye or both. In some cases, however, the patient has difficulty walking or moving one or more limbs and feels tingling, or ‘paresthesia’ in one part of the body “. The appearance, within a few hours, of one of these symptoms “must lead the family to subject the boy or girl to a neurological evaluation in a short time” recommends Valeriani according to which “the causes of the disease, even in its pediatric form, are not yet known. Instead – says the neurologist – we know better the pathogenetic mechanisms of the disease in which there is a real attack of the immune system directed against the central nervous system “.
The diagnosis of pediatric multiple sclerosis, as it happens for the adult, is formulated by the neurologist on the basis of the symptoms reported by the patient, the neurological examination and the results of instrumental and laboratory tests.. “Among these – underlines Valeriani – the magnetic resonance of the brain and spinal cord with or without contrast medium and the chemical, microbiological and immunological examination of the CSF, by lumbar puncture. Once the definitive diagnosis has been reached, if the patient continues to present neurological symptoms, they are subjected to high-dose corticosteroid therapy“.
This treatment – again Valeriani – “has primarily an anti-inflammatory action and serves to regress neurological symptoms. However, corticosteroid drugs do not stop the progression of the disease, characterized by the appearance of new areas of inflammation, which can cause symptoms. Fortunately though, there are several pharmacological treatments, defined as “modifying the course of the disease”, which hinder the pathogenetic mechanisms that lead to the recurrence of neurological symptoms and finally to the onset of permanent disabilities “.
Thanks to these drugs, the expectations of patients with multiple sclerosis, both children and adults, in terms of quality of life have changed radically in the last 20 years. “Their fate is different than a few years ago – underlines the head of the Multiple Sclerosis Center of the Bambino Gesù Pediatric Hospital, where about 50 patients are followed – because we have drugs that are able to stabilize the disease and prevent the formation of new areas of inflammation and therefore the appearance of symptoms that, in the long run, can lead to disability. The expectation of young patients with a diagnosis of multiple sclerosis is absolutely good, we now have the possibility of stopping the disease ”.
In children and adolescents with multiple sclerosis “it has been shown – adds Valeriani – that cognitive decline can also occur regardless of the appearance of motor and / or sensory symptoms and also in the presence of a stable lesion, on magnetic resonance. Therefore, the cognitive follow-up of pediatric patients with multiple sclerosis is extraordinarily important, because it allows this subtle progression of the disease to be highlighted in a timely manner and, therefore, to intervene effectively “. The complete intervention of the expert is available on: https://www.alleatiperlasalute.it/diagnosi/la-sclerosi-multipla-eta-pediatrica.