Multiple sclerosis and pediatric patient
Introduction
When there is an alteration in myelin, we can talk about a dysmicyelinizing or demyelinizing disease, the difference is that demyelinizing disease is a destruction of myelin which could be caused by multiple factors such as, for example, genetic, metabolic or infectious factors , while in the dysmielinizing disease there is a problem in the synthesis of myelin u in the conservation of this in the axon.
Demonicizing diseases despite having different causes, have a similar clinical picture, which hinders the diagnosis of each of them. Some of the demyelinizing diseases are: multiple sclerosis, acute disseminated encephalomyelitis, Marchiafava -ignami disease, among others. The most characteristic within demyelinizing diseases is multiple sclerosis. Multiple sclerosis is an CNS pathology which is an autoimmune disease, since the myelin sheath is attacked, causing a bad connection of the CNS and the rest of the body.
Developing
During the development of this disease, permanent deterioration or damage of nerves can be seen which is expressed with different symptoms, such as: numbness or weakness in one or more limbs that normally appear on the side of the body at the same time, or in the legs and the trunk, loss of partial or complete vision, usually in one eye at the same time.
Often with pain when moving, prolonged double vision, tingling or pain in different parts of the body, sensations of electric shocks that occur with certain neck movements, especially when tilting forward, this is known by the name of the sign of Lhermitte, tremors, lack of unstable coordination or march, babbling, fatigue, dizziness, problems with the functioning of intestines and bladder.
Multiple sclerosis pathophysiology
In the development of multiple sclerosis, various factors are participating as for examples immune mismatches, environmental factors, among others. However, despite the heterogeneous etiology that this disease presents, classical pathology involves perivenous inflammation, demyelination and gliosis. Myelin sheath is formed by multiple proteins which are released when myelin is destroyed. These proteins being free are recognized by the major histocompatibility complex type II, which allows the lymphocyte receiving complex to activate.
For the pathogenesis of this disease, the appearance of T lymphocytes that belong to an abnormal population that present an immunological deregulation that allows them to react to auto -antigens Tymphocytes T self-reactive. Once inside the CNS, T lymphocytes can produce 2 types of responses: TH1 and TH2, in the case of EM the type of response observed corresponds to TH1, that is, proinflammatory cytokines such as IL 2, TNF are produced and ifn.
The release of these pro -inflammatory cytokines will activate the macrophages, which are going to phagocyt the myelin, favoring the desalination and disappearance of the salting conduction, which begins the injuries present in the EM. Myelin sheath is of high importance for driving and for axonal protection, with this destruction there is a slowing or blocking of nerve driving [5].
Classification
- Referring-recurrent: The vast majority of patients 85% have such development
- Secondarily progressive: later 10-20 years arises from the installation of the first form presented where a decrease in the remisss are generally supplanted by a gradual worsening of neurological symptoms. When passing from time to years, neurological sequelae are commonly developed and the progression of early injuries are estimated.
- Primarily progressive: it occurs in a percentage of patients 15% is characterized by progressive and gradual neurological symptoms without remissions from the beginning.
- Progressive-recurrent: This classification enters into the progressive primary subtype that can be held overflowed with a slow progression. Differs from the sender-recurrent form in the shortage of brain and spinal injuries in RM.
Pediatric multiple sclerosis
Multiple sclerosis predominates in patients between 20 to 40 years of age, but does not mean that it does not exist in pediatric patients. The clinical picture that occurs in pediatric patients with EM is very diverse and is presented in a similar way to adults, where the most common neurological alterations are sensory, visual and motor types. Initially, 85% of patients have deficit episodes, followed by remissions and exacerbations. Relapse during the first year is manifested in 34% of cases.
conclusion
The age and clinical manifestations presented by patients are related, for example, ataxia, body hemiplegia and convulsive crises are frequent in children under 6 years. On the other hand, in children old. Pediatric multiple sclerosis is not diagnosed in time, since there is no common pattern among children, although they present adult -like clinical manifestations, they do not have the same magnitude.
In Venezuela there is an excellent program which has an important database for all patients with inflammatory diseases of the central nervous system which is administered by the Venezuelan National Security Institute. The data obtained by this program have allowed us Having an idea of the prevalence of this disease, also allows us to compare data from different countries and areas to deepen more in the knowledge of this disease.
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