Pediatric Multiple Sclerosis
Introduction
Introduction to multiple sclerosis in children Multiple sclerosis is an autoimmune demyelinating disease involving the white matter of the central nervous system. It is characterized by disseminated and multiple lesions, often with remission and recurrence. The onset is often in early adulthood, but in recent years, it is also more common. Reports of multiple child cases. Due to the presence of multifocal demyelinating plaques in the brain and spinal cord, clinical manifestations often manifest as dysfunction of multiple parts of the nervous system. basic knowledge Sickness ratio: 0.0001% Susceptible people: children Mode of infection: non-infectious Complications: ataxia edema liver abscess
Cause
Causes of multiple sclerosis in children
(1) Causes of the disease
The etiology of this disease has not been completely clarified. At present, it is generally accepted that the disease is an autoimmune disease induced by viral infection. The patient's self-reactive T cells are sensitized by a white matter antigen, and this self-reactive T cell enters the central nervous system. After systemic, together with non-specific T cells and macrophages lead to the destruction of myelin, genetic factors and environmental factors also play a role in the pathogenesis of this disease.
(two) pathogenesis
The typical manifestation is that there are many demyelinating plaques in the central nervous system, mainly found in the optic nerve, white matter and spinal cord around the ventricles. The plaques are mostly infiltrated by lymphocytes, plasma cells and macrophages, often distributed around the veins.
Prevention
Pediatric multiple sclerosis prevention
The etiology has not yet been elucidated, and it is believed that this disease is a T lymphocyte-mediated autoimmune disease associated with viral infection. Genetic factors play an important role in the susceptibility of this disease. Therefore, attention should be paid to genetic factors and active prevention and treatment of viral infectious diseases.
Complication
Pediatric multiple sclerosis complications Complications, ataxia, edema, liver abscess
Limb paralysis, paresthesia, ataxia, urinary dysfunction, mental or emotional changes, cerebral edema, seizures, cerebellar signs, pyramidal tract signs and post-somatic dysfunction are common, each recurrence remains new, permanent Sexual neurological impairment, multiple liver abscess is a serious and common complication of this disease.
Symptom
Symptoms of multiple sclerosis in children Common symptoms Double vision ataxia dysarthria intentional tremor eye muscle paralysis disorder convulsions paralysis
The age of onset is mostly 20 to 40 years old, and the incidence of diseases under 10 years old accounts for 3% to 5%. The onset can be urgent and slow, and the onset of children is more urgent. The first symptoms are vision loss (single or double eyes), diplopia or Extraocular muscle paralysis, paralysis of one or more limbs, paresthesia, ataxia, urinary dysfunction, intelligence or emotional changes, etc. Early childhood symptoms are often atypical, can be manifested as diffuse encephalopathy, meningeal response, cerebral edema , seizures and disturbances of consciousness, most of the fundus examinations are normal, and it can also be seen that optic discitis changes, cerebellar signs, pyramidal tract signs and post-somatic dysfunction are more common, ataxia, dysarthria and intentional tremor occur simultaneously, so-called Charcot Triad, if it can exclude other cerebellar diseases, it can be considered that the disease is caused by the disease, internuclear ophthalmoplegia and rotational nystagmus are also highly suggestive of the disease, the incidence of multiple sclerosis often begins with a focal symptom Subsequently, or at the same time, another symptom or symptoms that are not significantly related to the previous symptom appear, which indicates that there are multiple lesions in the central nervous system, thereby showing the clinical features of the disease.
Examine
Pediatric multiple sclerosis examination
There is no specific diagnostic method so far, but cerebrospinal fluid examination can find autoimmune antibodies in the central nervous system.
Cerebrospinal fluid examination: the number of cells is slightly elevated or normal, often transformed lymphocytes and plasma cells; protein is normal or slightly elevated; immunoglobulin can be increased in 70% to 90% of cases; less cloned IgG can be seen in 90% of cases Band (agar gel electrophoresis); myelin basic protein antibody can be detected positive in the relapse or exacerbation of the disease.
By brain stem evoked potential, CT or MRI, some demyelinating lesions with no clinical manifestations can be found, which can help to improve the diagnosis rate.
1. Evoked potential vision, auditory, somatosensory evoked potentials can help to find clinical lesions in the corresponding conduction pathway, or can be used as an indicator to predict disease recurrence.
2. CT or MRI can show demyelinating lesions in the white matter around the ventricle. MRI is more sensitive. A group of children aged 3 to 15 years old found that the positive rate of CT was 42%, and the positive rate of MRI was 87%. And more can show multifocal damage.
Diagnosis
Diagnosis and diagnosis of multiple sclerosis in children
diagnosis
The diagnostic criteria for multiple sclerosis are:
1. Clinical manifestations show that there are more than two lesions in the white matter of the central nervous system.
2. The history of recurrence and recurrence, the second episode is at least 1 month apart, each lasting more than 24h; or slowly progressing, the course of disease is more than half a year.
3. The onset age is 10 to 50 years old.
4. Other causes can be ruled out.
If the above conditions are met, the diagnosis of "clinically confirmed multiple sclerosis" is diagnosed.
For example, if one of the two items is missing, the diagnosis of "clinical high-sustained multiple sclerosis" is diagnosed.
If there is only one predilection site, the first episode can only be used as "clinically possible" or "clinical suspicious" multiple sclerosis.
With the improvement of the examination method, the standard has been revised abroad, such as the evoked potential, the clinical lesions found by CT or MRI are also calculated as a lesion; and if the cerebrospinal fluid electrophoresis has a small cloned IgG band or has an intrathecal If the amount of synthetic IgG is increased, the diagnosis can be increased to the first level. For example, the patient who is diagnosed as "clinically highly suspected" according to the traditional standard is changed to "experimental support diagnosis".
Differential diagnosis
The disease should be differentiated from acute disseminated encephalomyelitis, neuromyelitis and diffuse sclerosis.
