Manifestations of multiple sclerosis in children, current issues of therapy in pediatrics

Multiple sclerosis (MS) is a progressive disease of the nervous system. Symptoms become more severe as the disease progresses and may cause speech and motor difficulties. Multiple sclerosis can lead to difficulty performing everyday tasks and affect a person's quality of life.

There is no cure for MS, and treatments focus on prevention and symptom relief. MS is not as common in children as it is in adults.

Multiple sclerosis – a disease of the young?

Multiple sclerosis (MS) is an autoimmune disorder, the hallmark of which is demyelination of several foci, most often in the spinal cord, brain stem, cerebellum, cerebral hemispheres, and optic nerves. Subsequently, these numerous (scattered) foci are replaced by altered tissue. The development of the disease is characterized by a chronic paroxysmal-progressive (Latin “pro-gredior” - to go further) course.

There are approximately three million people living with MS around the world, and among these sufferers there are significantly more women than men, with a ratio of 3:1. The age of the patients varies from 16 to 50 years. The disease almost never occurs before the age of 16 and very rarely after the age of 50. Remissions (weakening) can have a large scope over time.

The etiology is unclear, and the question of the causative agent of the disease remains open. Today, the disease is considered multifactorial, and it is assumed that heredity, geographic location, and the presence of any viruses may be involved in its origin.

What is sclerosis

Multiple sclerosis is a common pathology of the nervous system. It is characterized by damage to the central nervous system, including a disorder of its peripheral parts.

This condition predominantly occurs in women aged 20-47 years. It is almost never found among males.

Sclerosis is detected more often in people who devote a lot of time to intellectual work, and whose nervous system is constantly in an excited state. But besides this, there are other reasons.

How does the disease affect the body?

The disease is divided into stages:

1. Initial;
2. Expanded;
3. Late.

The disease debuts with individual symptoms, for example, these may be: paraparesis (weakening of the muscle strength of the arms or legs), retrobulbar neuritis (visual impairment). Symptoms in the initial stage are erased and diagnosis is difficult. In the advanced stage, primary, secondary and tertiary symptoms are distinguished.

The most common primary symptoms are:

• Pyramidal disorders are represented by limitation or loss of motor function. When examined by a neurologist, the patient may exhibit a Babinski reflex (one of the pathological reflexes), which manifests itself in the fact that when stroking the sole of the foot, involuntary extension of the big toe occurs.
• Cerebellar disorders are represented by disturbances in coordination of movements and balance, a “drunk” gait, slowing down the rate of speech and pronouncing words in syllables; twitching of the eyeballs when they are abducted, trembling and clumsiness of the hands during voluntary purposeful action. For example, trembling increases when trying to hit the tip of the nose with a finger with closed eyes (intention tremor).
• Sensory disorders are almost as common as movement disorders. In the initial period, it looks like a “crawling sensation”; with further destruction of the myelin sheaths, it is expressed by the appearance of a feeling of numbness when touching sore spots.
• Visual impairment of varying severity.
• Slight hearing loss.
• Significant loss of pelvic organ function.

Secondary symptoms arise due to the body’s failure to respond to treatment. These include: bedsores, fragility and brittleness of bones, urinary tract infections, impaired trophism (nutrition) of tissues, contractures (stiffness) of the limbs.

Tertiary symptoms include psychological, professional, social, and marital problems.

In the late stage, a significant part of patients (50–80%) can no longer move independently, are incapacitated and have a disability group.

Mental disorders associated with this pathology include:

1. Affective disorders (depression, less often euphoria);
2. Neurosis-like disorders;
3. Decreased mental functions.

Chronic illness

Multiple sclerosis is a chronic disease that affects parts of the central nervous system - the brain and spinal cord. The disease is associated with a disruption of the immune system; more precisely, it is autoimmune in nature. The cause of the development of sclerotic changes is an inflammatory process activated by immune cells, as a result of which the myelin sheath of the nerves is replaced by connective (scar) tissue of various sizes. Plaques form on nerve fibers, which disrupt the conduction of nerve impulses. The brain loses the efficiency of controlling various processes, which can result, for example, in difficulty in voluntary movements or decreased sensitivity.

Some factors can provoke the development of multiple sclerosis:

• Hereditary predisposition
• Stressful situations,
• Infectious diseases,
• Vitamin D deficiency.

The disease is quite common, and women and girls (if we mean children) aged 15–40 years are more often affected. A racial pattern was also identified. Thus, Europeans get sick much more often than people of other races. The connection with vitamin D deficiency in the body has also been studied.

The disease develops slowly. At first, the manifestations are mild. This is due to the fact that intact nerve cells in the brain compensate for the work of the affected areas for a certain time.

When the extent of damage reaches 50%, the first initial clinical manifestations appear:

• Vision is impaired - pain and double vision,
• Muscles weaken
• Skin sensitivity decreases,
• Coordination of movements is impaired,
• There is tingling and numbness in the fingertips.

As the disease progresses, other signs and characteristics appear in the child: increased fatigue, muscle spasms and pain, incomplete paralysis of the limbs or paralysis of the facial nerves, disturbances in the voluntary emptying of the intestines and bladder, intellectual impairment and emotional disorders (changes in states of depression and euphoria). Increasing the room temperature or taking hot showers and baths can trigger an attack of the disease.

To accurately diagnose multiple sclerosis, you must:

• The presence of at least two cases of manifestation of multiple sclerosis lasting up to a day with an interval of a month between them.
• Magnetic resonance imaging identified foci of sclerosis, i.e. areas of demyelination.
• In addition, an immunological blood test or electromyography should be performed. About 25% of cases of the disease have a benign course. Patients remain functional for quite a long period. In 10% of cases, disability may occur within 5 years.

Today, the treatment of this disease is still symptomatic, since a universal cure for the pathology has not yet been found. There are two types of treatment, which depend on the form of the disease:

• Treatment during an exacerbation: it is recommended to take cortisone and adrenocorticotropic hormone
• Treatment during the improvement period is carried out to help nerve cells restore their functions, as well as protect the brain from attack by the immune system. These are drugs such as Cyclosporin A, Methotrexate, Azathioprine, Immunoglobulin, etc.

Differences in the manifestation of MS in children

MS is a progressive disease that requires treatment of symptoms. The disease in infants, children and adolescents is similar to MS in adults. However, there are some differences:

• Children experience more frequent relapses—during which symptoms become significantly worse.
• Children with MS often have brain damage, according to research.
• Children begin to experience difficulties with memory, concentration and speech approximately 2 years after diagnosis. Depression may develop at this time.

Studying these features can help children and parents better understand the disease and its progression.

Some potential risk factors:

• hereditary predisposition;
• vitamin D deficiency;
• onset of puberty in women;
• exposure to the Epstein-Barr virus;
• exposure to passive smoking.

Therapeutic exercises for multiple sclerosis

Multiple sclerosis in children is currently an incurable disease that can affect both young and adult people. Typically, this disease most often occurs in people between fifteen and forty years old. This disease affects the myelin sheath of the spinal cord and brain.

People with multiple sclerosis begin to have difficulty walking over time. Coordination is greatly impaired. Weakness and fatigue occur. In this regard, to care for the body, doctors recommend that patients do special light gymnastics as often as possible.

Since patients with this diagnosis may have different stages of deterioration in mobility, procedures for all types of groups will be described below. Check out the list and choose the exercises that suit you.

However, these manipulations are intended for those who can still perform them independently to improve joint mobility.

These procedures prolong the periods between exacerbations and slow down the progression of the disease, as cellular metabolism in the affected areas of the nervous system is stimulated. As a result, sensitivity increases significantly.

So, in order to avoid deformation of the limbs and to improve the abilities of muscles, joints and tendons, gymnastics is simply irreplaceable. These exercises should be performed slowly, without haste. Otherwise, the patient may experience undesirable consequences. As for the execution time, everything is individual. The patient should carry out the procedures before the first appearance of discomfort occurs. At the beginning, the exercises should be done no more than five times a day. The pace should be moderate. Over time, the number of repetitions and tempo can be increased slightly. As a result, these exercises will have to be performed painlessly 10 times.

Therapeutic exercises for the neck

Before you start doing gymnastics, you need to find a comfortable position. Preferably sitting. But, if sitting is uncomfortable, then, in principle, you can lie down. Relax and lower your shoulders. Keep your head straight. Tilt your head back with smooth movements. In this case, you need to bring your shoulder blades together. Then slowly lower your head forward. You need to look where your head turns. We lower it to the chest until it stops. After this, we fix the head again in its original position.

We tilt our head to the right as much as possible. Try to touch your ear to your shoulder. Then slowly tilt your head to the left until it stops. Or how you get it.

Then, slowly, turn your head as far to the right as possible. With your eyes, follow the direction in which your head is turning. Also, slowly, turn your head to the left.

In the future, when you get the hang of it, try to press in the opposite direction with your palms as an additional load. If during these exercises you experience dizziness, nausea or pain, you should immediately interrupt the procedure and consult your doctor for advice.

By the way, if you are diagnosed with multiple sclerosis, when you lower your head down, you may feel as if you were hit by an electric shock. This is fine. This happens in most patients.

Therapeutic exercises for hands

First you need to lie down. We do the exercise with one hand, and then repeat with the second. Raise your arm vertically. The shoulder should come off the bed. Then lower your arm as far back as possible. It is desirable that she can touch the surface on which you are lying. After pausing a little, we smoothly return the hand back. Try to touch the bed with your shoulder. The hand should be turned to the side until it touches the head. Then we return to the starting position.

Therapeutic gymnastics for fingers

It is more convenient to perform these movements while sitting or standing. Hold your palm with your fingers pressed together. Then try to spread all your fingers out to the side as much as possible. After this we return to the starting position. Now we clench our fingers into a fist, pressing them with our thumb. Try to squeeze as hard as possible. Then we unclench our fingers.

Therapeutic exercises for toes

Sit or lie down to begin the gymnastics. Try to spread your fingers as far apart as possible. Then we return them back. Then we bend our toes forward, pressing them to the foot. Then we try to turn our fingers in the opposite direction as much as possible. We perform the same manipulations with the legs and arms, bending and arching all joints.

Diagnostics

As a result of the constant alternation of exacerbations and remissions, the diagnosis of multiple sclerosis can be difficult and take a long time. To confirm the disease, a set of studies is used, which helps to assess the state of the nervous system and the nature of the spread of the pathological process.

At the first stage, the patient is interviewed, identifying his complaints, general health and the onset of the disease. Additionally, a series of instrumental studies are prescribed to create a clear picture of multiple sclerosis. Among them are used:

1. ​CT and MRI.
2. ​Inspection of potentials.
3. ​Laboratory methods, in particular the study of cerebrospinal fluid and blood.

Based on such data, differential diagnosis is carried out, since the disease, in its symptoms and nature of the course, is similar to many conditions.

Prevention

The main thing is strict adherence to the regime. Sleep should be full and eight hours long. Food and drink should not be too hot. You should do physical therapy (physical therapy) every day and give up various bad habits; beware of ARVI and avoid overwork and conflicts with others. Some doctors recommend not to forget about good old fish oil. In our country, treatment is carried out, as a rule, not in specialized clinics, but in ordinary ones by a neurologist. Patients must strictly adhere to the doctor’s orders and, if possible, keep the body in a state of stable remission.

Treatment may include:

• Hormonal therapy to reduce the severity of exacerbations;
• Interferon preparations;
• Plasmapheresis to cleanse the body using blood.

Symptomatic therapy involves the prescription of antidepressants, nootropics, vitamins, and vasodilators. Physiotherapy, massage, psychotherapy are used.

The goal of the rehabilitation process is to preserve the patient’s ability to work for as long as possible. During recovery, an interdisciplinary approach is used, and the team of specialists, in addition to a neurologist, includes a physical therapy methodologist, a speech therapist, a neuropsychologist, a physiotherapist, and a nutritionist. The participation of representatives of social services and the MS community, friends and relatives of the patient is also necessary.

The patient himself as a subject of activity must be included in a successful rehabilitation process. This can be facilitated by providing him with all the information about the disease, the progress of treatment and the future prognosis. Creating an individual rehabilitation program with the participation of all specialists increases the effectiveness of maintenance therapy. A drug that interrupts the course of multiple sclerosis has not yet been invented. But maybe a stem cell transplant will change the picture of the disease for the better, and someone will live long enough to be saved.