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儿童多发性硬化的治疗与预后

Author
Timothy E Lotze, MD
Section Editors
Marc C Patterson, MD, FRACP
Francisco González-Scarano, MD
Deputy Editor
John F Dashe, MD, PhD
Translators
兰莉, 副主任医师，副教授

引言

通常将多发性硬化(multiple sclerosis, MS)视为年轻成人的疾病。然而，人们越来越多地识别到儿童MS(pediatric MS)，定义为18岁之前发病的MS，在所有病例中约占5%[1]。该病曾被称为早发型MS(early onset multiple sclerosis, EOMS)和青少年型MS。

儿童MS罕见，因此当儿童出现急性神经系统症状反复发作且脑MRI提示白质病变时，临床医生可能首先考虑白质营养不良、血管病、结节病、淋巴瘤、线粒体缺陷和其他代谢性疾病等鉴别诊断，而非MS。鉴于MS疾病修正治疗(disease modifying therapy)的可用性和诊断对未来预后的影响，所以对所有存在白质病变的儿童都要考虑儿童MS的可能性，这点十分重要。 (参见“儿童中枢神经系统急性脱髓鞘疾病的鉴别诊断”)

MS儿童的预后和治疗不同于更常见的成人型MS，且很大程度上研究不足。本专题将总结儿童MS的治疗和预后。关于治疗的部分参考来自成人，因为儿童MS的资料有限，而且推测成人和儿童MS对治疗的反应可能相似。

儿童MS的发病机制、临床特点和诊断将单独讨论。 (参见“儿童多发性硬化的发病机制、临床特征和诊断”)

预后

MS导致的残疾进展情况差异很大，但是越来越多的数据提示，大多数MS成人进展缓慢。 (参见“多发性硬化的临床病程和分型”，关于‘恶化速率’一节)

                

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Literature review current through: 2017-06 . | This topic last updated: 2017-05-08.
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