Pediatric multiple sclerosis and fulminant disease course: Features and approaches to treatment – A case report and review of the literature. (July 2018)

• Record Type: Journal Article
• Authors: Sandi, Dániel; Bereg, Edit; Biernacki, Tamás; Vörös, Erika; Klivényi, Péter; Bereczki, Csaba; Vécsei, László; Bencsik, Krisztina
• Is Part Of: Journal of clinical neuroscience. Volume 53(2018)
• Page Start: 13
• Page End: 19
• Publication Date: 2018-07
• Subjects: Pediatric multiple sclerosis -- Fulminant multiple sclerosis -- Tumefactive lesions -- Acute disseminated encephalomyelitis -- Disease modifying treatment -- Hungary; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2018.04.053
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Report of the first successful natalizumab treatment as a first-choice drug in pediatric tumefactive MS. A comprehensive summary on the differences between adult-onset and pediatric-onset MS. We provided the latest data on the management of pediatric patients. We provided a comprehensive summary on the fulminant disease course. Abstract: Multiple sclerosis (MS) is the autoimmune, neurodegenerative disease of the central nervous system (CNS). Typically, it affects the young adult population, however, up to 10% of the cases, it can develop in childhood. Atypical manifestations, such as the tumefactive variant (tMS) or acute disseminated encephalomyelitis (ADEM), especially coupled with fulminant disease course, are even more rare and pose a considerable differential diagnostic and therapeutic challenge. Recently, the therapeutic strategy on the use of disease modifying therapies (DMTs) in MS has shifted to the direction of a more individualized approach, that takes the personal differences heavily into account, in particular regard to the activity and prognosis of the disease. Despite this change has only been applied to adults yet, it is plausible to predict, that it will soon be applied to pediatric patients as well, particularly, as several randomized studies are under way concerning DMTs in pediatric populations. To our best knowledge, we are the first to report a successful natalizumab treatment of pediatric fulminant tMS, in case of a 13.5 years old girl. We feel that this report demonstrates the need of early and adequate treatment in such an aggressive case, because it can reverse the course of a possibly fatal disease.