Pediatrik Multipl Sklerozda Tedavi Yönetimi
Özet
Multipl skleroz (MS), santral sinir sisteminin kronik, ilerleyici ve relapslarla seyreden demiyelinizan bir hastalığıdır. Vakaların %3-7’si pediatrik yaş grubunda başlar. Çocukluk çağı MS'i genellikle relapsing-remitting fenotipinde görülür ve erişkinlere kıyasla daha sık ve şiddetli ataklarla seyreder.
Tedavi stratejileri akut atak tedavisi ve uzun süreli hastalık modifiye edici tedaviler olarak ikiye ayrılır. Akut ataklarda yüksek doz intravenöz metilprednizolon, intravenöz immünglobulin ve plazma değişimi tercih edilir. Uzun süreli tedavide interferon beta, glatiramer asetat ve teriflunomid gibi birinci basamak tedaviler, daha dirençli vakalarda fingolimod, dimetil fumarat ve monoklonal antikorlar (natalizumab, okrelizumab) kullanılır.
Son yıllarda yüksek etkinlikli tedavilere erken başlanmasının hastalık progresyonunu azalttığı gösterilmiştir. Ancak çocuklarda tedaviye ilişkin kanıta dayalı veriler sınırlıdır. MS'li çocuk hastaların multidisipliner bir yaklaşımla izlenmesi, bilişsel ve psikososyal desteğin sağlanması önemlidir. Aşılama ve enfeksiyon taramaları tedavi sürecinin ayrılmaz bir parçasıdır.
Multiple sclerosis (MS) is a chronic, progressive, and relapsing-remitting demyelinating disease of the central nervous system. Approximately 3-7% of cases have a pediatric onset. Pediatric MS predominantly follows a relapsing-remitting course, with more frequent and severe attacks compared to adult-onset MS.
Treatment strategies are classified into acute attack management and long-term disease-modifying therapies. Acute attacks are primarily managed with high-dose intravenous methylprednisolone, intravenous immunoglobulin, and plasma exchange. Long-term treatment includes first-line therapies such as interferon-beta, glatiramer acetate, and teriflunomide, whereas more refractory cases require second-line agents like fingolimod, dimethyl fumarate, and monoclonal antibodies (natalizumab, ocrelizumab).
Recent studies suggest that early initiation of high-efficacy treatments may mitigate disease progression. However, evidence-based data on pediatric MS treatment remain limited. A multidisciplinary approach is essential for managing pediatric patients, ensuring cognitive and psychosocial support. Vaccination and infection screening are integral components of the therapeutic process.
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