Pediatric-onset multiple sclerosis (POMS) - diagnosis, treatment and psychological aspects

Introduction and Objective.Paediatric-onset multiple sclerosis (POMS) is a chronic, immune-mediated disease of the central nervous system that manifests before the age of 18.Although relatively rare, it poses unique diagnostic and therapeutic challenges due to differences in immune system maturity, disease presentation, and response to treatment compared to adult-onset MS.Review Methods.The review systematically synthesizes evidence from various studies to provide a comprehensive overview of POMS, integrating findings on its etiology, diagnosis, treatment, and psychosocial impact.Brief description of the state of knowledge.The pathogenesis of POMS involves both T and B cell dysregulation, with particular attention paid to the role of IL-17, Epstein-Barr virus infection, HLA-DRB1 phenotype, and environmental factors such as vitamin D deficiency.Diagnostic accuracy has improved through the use of the 2017 McDonald criteria, MRI imaging, cerebrospinal fluid analysis, and detection of specific antibodies.Treatment approaches range from corticosteroids for acute relapses to long-term disease-modifying therapies.First-line immunomodulatory agents, such as interferon- and glatiramer acetate, are increasingly supplemented or replaced by modern oral medications (e.g., fingolimod, dimethyl fumarate) and monoclonal antibodies (e.g., rituximab, ocrelizumab, natalizumab).In addition to biomedical management, the disease significantly affects the psychological functioning of patients, their cognitive development, and family dynamics.A holistic, multidisciplinary approach that includes psycho-social support is essential for improving long-term outcomes and quality of life for both the children and their caregivers.Summary.The review presents a comprehensive analysis of current knowledge on the etiology, diagnostic methods, treatment strategies, and the psycho-social impact of POMS.