Zusammenfassung
Die multiple Sklerose (MS) gilt als Erkrankung des jungen Erwachsenenalters, jedoch ist die MS auch bei Kindern und Jugendlichen keine seltene Krankheit. Wenngleich es sich grundsätzlich bei der MS im Kindes- und im Erwachsenenalter um die gleiche Krankheit handelt, gibt es wichtige Besonderheiten der kindlichen MS hinsichtlich der Differenzialdiagnosen, der Symptomatik, des Krankheitsverlaufes und der Therapie. Hervorzuheben ist hierbei insbesondere die im Vergleich zur Erwachsenenform der MS günstigere Prognose, die u. a. aus dem im Kindesalter geringen Prozentsatz primär und sekundär chronisch progredienter Krankheitsverläufe resultiert. Trotz der insgesamt besseren Prognose der MS im Kindesalter ist zur Verlangsamung der Krankheitsprogression neben der immunsuppressiven Schubtherapie ein rechtzeitiger Einsatz immunmodulatorischer Therapien zu empfehlen. Kritisch abzuwägen ist hierbei der potenzielle therapeutische Nutzen gegen die noch unbekannten Langzeitrisiken einer solchen Therapie. Die medikamentöse Behandlung sollte jedoch im Kindes- und Jugendalter immer Teil eines umfassenden Therapiekonzeptes sein, welches neben der Physiotherapie auch eine individuelle psychosoziale Betreuung beinhalten muss.
Multiple Sclerosis in Children and Adolescents
Multiple sclerosis (MS) is considered to be a disease of young adulthood, but it should be noted that cases in childhood and adolescence are not rare. Principally, childhood MS and MS in the adult age are the same disease. Nevertheless, there are some important differences concerning possible differential diagnoses, symptoms, clinical course and therapy. Of special interest is the fact that the prognosis of MS in childhood seems to be better than that of MS in the adult age, partially as a consequence of the lower percentage of primary and secondary progressive courses. Despite the fairly good prognosis of childhood MS, a consequent immunosuppressive treatment of acute attacks as well as a timely immunomodulatory therapy to slow down the progression of the disease is to be recommended. Yet the potential therapeutic benefit of such a treatment has to be carefully balanced against the presently unknown long-term risks of an immunomodulation early in life. Additionally, pharmacotherapy of childhood MS should always be part of a comprehensive therapeutic concept also considering physiotherapeutic and individual psychosocial care.
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Prof. Dr. med. Dr. h. c. F. Hanefeld
Schwerpunkt Neuropädiatrie der Universitätskinderklinik
Georg-August-Universität Göttingen
Robert-Koch-Straße 40
37073 Göttingen
eMail: dpohl@med.uni-goettingen.de
