General Principles of Treatment of Multiple Sclerosis in Children

Introduction. Taking care of children with multiple sclerosis (MS) requires coordinated efforts of parents and a multidisciplinary medical team: pediatricians, physiotherapists, psychologists, urologists, nurses. Care should ensure maximum improvement in the quality of life of a small patient, especially during the exacerbation of MS. Aim. To describe the current general principles of treatment of MS in children. Materials and methods. The article describes the main approaches to the use of approved medicines: interferon-β1b, glatiramer acetate, iterferon-β1a s/c, interferon-β1a i/m, mitoxantrone (Cyclophosphamide), Tizabri (natalizumab) in children with multiple sclerosis. Also the results of clinical trials conducted in children with MS are described. Results. Symptoms of the exacerbation of MS can occur and increase from a few days to several weeks, although for very young children, there is a sudden beginning. Emergency medical care is needed for children who have symptoms of relapse of the MS disrupting functions or causing discomfort. The mild symptoms of MS that do not violate the patient's function do not require medication. Most children are well tolerated with corticosteroids, but minor side effects are possible. Children with frequent recurrence of MS require repeated courses of pulse therapy with methylprednisolone. Such children may experience glucocorticoid complications, including osteoporosis, avascular necrosis, hyperglycemia, obesity, leg swelling, adrenal dysfunction, acne, cognitive impairment, cataract, glaucoma and hypertension. Side effects of glucocorticoid effect should be minimized and not using prolonged scheme (over 21 days) of methylprednisolone. Intravenous immunoglobulin is used as an alternative treatment for the exacerbation of MS in children with frequent relapses, inadequate pulsed therapy with solumederol or its pronounced side effects. As of today, there are six officially approved drugs for the treatment of remitting-recurrent type of MS: three forms of interferon-β (IFN-β) (Rebif®, Avonex, Betaferon®); Glyamerate Acetate (Copakson®-Teva); Mitoxantrone (Mitoxantrone “EBE-BE”) and natalizumab (Tizabri). The pathogenetic treatment should be initiated immediately after the confirmation of the diagnosis of MS, since efficacy is higher in the early stages of the disease. IFN-β and glutamomer acetate are safe, tolerant, and effective, since they reduce the frequency of relapses in the early stages of the disease. Conclusions. Undoubtedly, treating patients with MS, it is very important to act in accordance with the recommendations based on the evidence base, not forgetting the individual approach to patients, taking into account the clinical form and type of progression of the disease.