Multiple Skleroz Tedavisinde Potansiyel Komplikasyonlar ve Yönetimi
Özet
Bu bölüm, pediatrik multipl skleroz (MS) tedavisinde kullanılan immünomodülatör ve immünsüpresif ajanların potansiyel komplikasyonları ve yönetimine odaklanmaktadır. Çocukluk çağında MS tedavisinde kullanılan enjeksiyon, oral ve infüzyon yoluyla uygulanan ilaçların yan etkileri detaylı şekilde ele alınmış, özellikle enfeksiyon riski, fırsatçı enfeksiyonlar, hepatit B ve tüberküloz reaktivasyonu gibi önemli komplikasyonlar tartışılmıştır. Ayrıca, anti-CD20 tedavileri ile ilişkili hipogammaglobulinemi ve progresif multifokal lökoensefalopati (PML) riski değerlendirilmiştir. Her bir ilacın kullanım öncesinde ve sırasında yapılması gereken taramalar, hasta takibi ve olası komplikasyonlara karşı alınması gereken önlemler açıklanmıştır. Bölümde ayrıca akut atak tedavisinde glukokortikoidlerin ve plazmaferezin rolü, bu tedavilerin yan etkileri ve izleme protokolleri aktarılmıştır. Tedavi sürecinde enfeksiyon riskinin azaltılması, aşılama önerileri, immünoglobulin düzeylerinin takibi ve PML gelişiminin erken tanısı için gerekli olan yaklaşımlar da vurgulanmaktadır. Pediatrik MS hastalarında, immünmodülatör ve immünsüpresif tedavi sürecinde güvenli ve etkili yönetim stratejilerinin oluşturulması için kapsamlı bilgiler sunulmaktadır.
This chapter focuses on the potential complications and management strategies of immunomodulatory and immunosuppressive agents used in pediatric multiple sclerosis (MS) treatment. It comprehensively discusses side effects of injectable, oral, and infusion therapies commonly used in childhood MS, emphasizing infection risks, opportunistic infections, hepatitis B and tuberculosis reactivation. The risk of hypogammaglobulinemia and progressive multifocal leukoencephalopathy (PML) associated with anti-CD20 therapies is also evaluated. The chapter outlines pre-treatment screenings, monitoring protocols, and precautionary measures to be taken against potential complications for each medication. Additionally, it addresses the role of glucocorticoids and plasmapheresis in acute relapse management, including side effects and monitoring strategies. Key topics include recommendations for vaccination, strategies to reduce infection risks, immunoglobulin level monitoring, and approaches for early detection of PML in pediatric patients. The chapter provides comprehensive guidance to ensure the safe and effective management of immunomodulatory and immunosuppressive therapies in children with MS. It highlights the importance of individualized treatment plans and regular patient assessments to mitigate potential risks and optimize therapeutic outcomes in pediatric multiple sclerosis care.
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