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Chapter 54 - Management of pediatric multiple sclerosis

from Section IV - Therapy in clinical practice

Published online by Cambridge University Press:  05 December 2011

By
E. Ann Yeh  and
Bianca Weinstock-Guttman
Edited by
Jeffrey A. Cohen  and
Richard A. Rudick
Jeffrey A. Cohen
Affiliation:
Cleveland Clinic
Richard A. Rudick
Affiliation:
Cleveland Clinic
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Summary

Randomized, controlled trials of therapies for acute multiple sclerosis (MS) relapses have not been conducted in children. Clinical practice in the pediatric population is, therefore, based largely on adult practices. The treatment is based on steroids, intravenous immunoglobulin, and plasma exchange. This chapter discusses first-line disease modifying therapies using Interferon beta and glatiramer acetate, and second-line disease modifying therapies. It reviews immunomodulatory and cytotoxic agents that have been used in treatment-resistant cases, and the agents include natalizamab, CTX, mitoxantrone, rituximab. The oral agents described in the chapter are fingolimod, cladribine and IVIg. The approaches to frequently encountered psychosocial problems and symptoms in pediatric MS are: educational support, mobility, spasticity, affective disorders and depression and fatigue. Pediatric MS has been shown to carry a greater disease burden than adult MS, both in terms of annualized relapse rate and magnetic resonance imaging (MRI) parameters.

Keywords

tissue injury modelmultiple sclerosisneural repairT-cell proliferationmesenchymal stem cell transplantationB-cell proliferationimmunomodulatory properties
Type
Chapter
Information
Multiple Sclerosis Therapeutics , pp. 632 - 644
Publisher: Cambridge University Press
Print publication year: 2011

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