Vol. 29/2020 Issue 58
okładka czasopisma Child Neurology
powiększenie okładki
Journal Info

CHILD NEUROLOGY

Journal of the Polish Society of Child Neurologists

PL ISSN 1230-3690
e-ISSN 2451-1897
DOI 10.20966
Semiannual


Powrót

Stwardnienie rozsiane u dzieci: objawy kliniczne, diagnostyka, różnicowanie i leczenie


Multiple sclerosis in in children: clinical symptoms diagnosis, differential diagnostics and treatment




Specjalistyczny Gabinet Neurologii Dziecięcej, Wrocław

Neurol Dziec 2010; 19, 37: 75-82
Full text PDF Stwardnienie rozsiane u dzieci: objawy kliniczne, diagnostyka, różnicowanie i leczenie



STRESZCZENIE
Stwardnienie rozsiane (SM) u dzieci jest w ostatnich latach coraz lepiej poznane w aspekcie epidemiologii i objawów klinicznych. Kliniczna manifestacja SM u dzieci jest różnorodna. Początek jednoobjawowy (CIS), powyżej 10 roku życia, występuje w 53% przypadków i u 52% tej grupy dotyczy zapalenia nerwu wzrokowego. U większości dzieci występuje postać z rzutami i remisjami SM (RRSM, Relapsing-Remitting SM). Rozpoznanie SM u dzieci nastręcza szereg problemów, ponieważ niektóre zespoły chorobowe mogą mieć podobną albo taką samą symptomatologię. Badaniem z wyboru potwierdzającym rozpoznanie jest rezonans magnetyczny (MR). Jego interpretacja powinna być dokonana w oparciu o powszechnie przyjęte kryteria McDonalda. Diagnostyka różnicowa obejmuje liczne schorzenia, takie jak: ostre rozsiane zapalenie mózgu i rdzenia (ADEM), choroby naczyniowe mózgu (udar niedokrwienny), neuroboreliozę, encefalopatie mitochondrialne, leukodystrofie i inne. Rokowanie długoterminowe niekorzystne. Po 20 latach stopień inwalidztwa w skali EDSS wynosi 4 pkt. Choroba ma także niekorzystny wpływ na funkcje poznawcze, zwłaszcza w przypadkach o bardzo wczesnym początku. Leczenie immunomodulacyjne stosowane u dorosłych jest dobrze tolerowane u dzieci i wymaga monitorowania funkcji wątroby i parametrów hematologicznych.

Słowa kluczowe: stwardnienie rozsiane u dzieci, objawy kliniczne, leczenie


ABSTRACT
Recently multiple sclerosis (SM) in children has been increasingly better recognized with regard to epidemiology and clinical symptoms. The clinical manifestations of SM in children are diverse. One-symptom onset (CIS, Clinically Isolated Syndrom) in children takes place in 53% of over the age of 10 and very often involves inflammation of the optic nerve in more than 52% of patients. Most children with SM have a relapsing-remitting (RRSM) form of the disease. Diagnosing SM in children presents many problems because some of the disease units may have similar symptoms or they may be hard to distinguish. Test which confirms diagnosis of SM is magnetic resonance. Its interpretation should be made on the basis of the commonly adopted McDonald’s criteria. The differential diagnostics covers numerous diseases, such as acute multiple brain and spine inflammation, vascular-cerebral diseases, neuroborreliosis, mitochondrial encephalopathies, leukodystrophies and others. The long-term prognosis in children is unfavourable. The level of disability is already 4 points on the EDSS (Expanded Disability Status Scale) after 20 years. The disease also has a negative impact on cognitive functions. Immunomodulatory therapies approved for use in adults with SM are well tolerated in children, although monitoring of liver function is of a particular importance.

Key words: multiple sclerosis in children, clinical manifestations, treatment


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