Pediatrik Multipl Sklerozda Tanı Yöntemleri
Özet
Pediatrik multipl skleroz (pMS), 18 yaş altındaki çocuklarda merkezi sinir sisteminde (MSS) demiyelinizasyonla karakterize edilen otoimmün bir hastalıktır. pMS, erişkin MS’e benzerlik gösterse de klinik, nörogörüntüleme ve tedavi farklılıkları içerir. Tanıda en az bir klinik atak ve manyetik rezonans görüntüleme (MRG) ile MSS’de demiyelinizan lezyon tespiti gereklidir. 2017 McDonald kriterlerine göre mekanda ve zamanda yayılımın gösterilmesi tanı için önemlidir. Tanıda laboratuvar testleri ve beyin omurilik sıvısı (BOS) analizi kullanılır. Tedavi öncesinde ayırıcı tanı için antikor testleri yapılır. Pediatrik MS için BOS analizi ,MOG IgG ve Aqp-4 IgG testi önerilir. Oligoklonal bantların (OLB) varlığı tanıyı destekler. MRG’de farklı bölgelerde lezyonların gösterilmesi ve kontrast tutulumunun saptanması tanıyı destekler. 2024 ECTRIMS önerilerine göre, 5 anatomik bölgeden en az ikisinde tutulum, SVİ (santral ven işareti) ve PHL (paramanyetik halka lezyonu) gibi bulgular tanıyı güçlendirir. Anahtar Kelimeler: pediatrik multipl skleroz, demiyelinizasyon, tanı kriterleri, McDonald kriterleri, oligoklonal bant, manyetik rezonans görüntüleme.
Pediatric multiple sclerosis (pMS) is an autoimmune disease characterized by demyelination in the central nervous system (CNS) in children under 18 years of age. Although pMS shares similarities with adult MS, it exhibits differences in clinical presentation, neuroimaging, and treatment. Diagnosis requires at least one clinical attack and evidence of demyelinating lesions in the CNS on magnetic resonance imaging (MRI). According to the 2017 McDonald criteria, evidence of dissemination in time and space is essential for diagnosis. Laboratory tests and cerebrospinal fluid (CSF) analysis are used to aid diagnosis. Antibody tests are performed to exclude differential diagnoses before starting treatment. Testing for MOG IgG, Aqp-4 IgG and CSF analysis are recommended for pediatric MS. The presence of oligoclonal bands (OLB) supports the diagnosis. The detection of lesions in different regions on MRI and the presence of contrast enhancement strengthen the diagnosis. According to the 2024 ECTRIMS recommendations, involvement in at least two of five anatomical regions, findings such as central vein sign (CVS) and paramagnetic ring lesions (PRL) are important for diagnosis.
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