Pediatric Multiple Sclerosis: Clinical, Diagnosis and Therapeutic Approach

Abstract Multiple Sclerosis (MS) in pediatric age accounts for about 10% of cases of multiple sclerosis, defining as infantile form that onset before 10 years of age, and adolescent form that at the beginning between 10 and 18 years. The current diagnostic criteria for MS in McDonald's adult age can be ap plied to the pediatric age if the initial presentation of the disease is not an acute encephalopathy. As for adults, the triggering factor of the inflammatory process in the CNS is related to an immunological alteration on the basis of which T cells play a fundamental role in particular in relation to various antigenic stimuli. The diagnostic evaluation is based on the history, physical examination, blood tests, liquor and neuroimaging. In pediatric early onset forms, MOG (glycoprotein oligodendrocita anti- myelin) and MBP (basic antimyelin protein) are often present. The initial symptoms of MS vary significantly, often with difficulty in detecting modest symptoms such as changes in sensitivity. Often the initial symptom may be an encephalopathy (like ADEM) or an optic neuropathy with onset with a convulsive episode. The course is generally relapsing remitting. The EDSS score, disability index, in pediatric forms is generally lower than in adults. Patients with MS in children should be considered for treatment with both beta interferon and glatiramer acetate, as first line drugs, unless there is a specific contraindication to the use of the two products. The knowledge gained on the use of DMTs in adults (early and long term) is in favor of their early use even in pediatric age