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Anti-CD20 therapies have established efficacy in the treatment of immune-mediated neurological and non-neurological diseases. Rituximab, one of the first B-cell-directed therapies, is relatively inexpensive compared to newer anti-CD20 molecules, is available in many countries, and has been used off-label in pediatric patients with neuroimmune conditions. The objective of this paper is to describe the experience with rituximab in pediatric multiple sclerosis and other inflammatory immune-mediated disorders of the central nervous system (CNS), and to define a protocol for its use in clinical practice, in particular addressing doses, interval of administration, duration of treatment, and tests to perform at baseline and during follow-up. [ABSTRACT FROM AUTHOR]

The article examines the significant use of antigen arrays in identifying the profiles of serum anti-myelin autoantibody that can distinguish acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS). The study shows the unique anti-myelin autoantibody profiles of MS and ADEM sera. It indicates the higher autoantibody reactivity of almost all differentiating immunoglobulin G-targeted antigens among patients with ADEM.

The article presents a study which aims to revise the 2007 definitions of pediatric multiple sclerosis (MS) to integrated advances. Revised criteria are proposed for pediatric neuromyelitis, pediatric clinically isolated syndrome and pediatric acute disseminated encephalomyelitis. The criteria was approved by 93% of the 56 members of the International Pediatric Multiple Sclerosis Study Group (IPMSSG) who responded to the final survey.

To expand current knowledge, we examined the safety and tolerability of subcutaneous interferon β-1a in patients with pediatric-onset multiple sclerosis. Records from 307 patients who had received at least 1 injection of subcutaneous interferon β-1a for demyelinating events when aged younger than 18 years were reviewed. Overall, 168 (54.7%) patients had at least 1 prespecified medical event related to or under close monitoring with subcutaneous interferon β-1a or specific to pediatric patients, 184 (59.9%) had nonserious medical events related to treatment or of unknown causality, and 12 (3.9%) had serious medical events irrespective of causality. The most common laboratory abnormalities were increased alanine (74/195; 37.9%) and aspartate aminotransferase levels (59/194; 30.4%). Annualized relapse rates were 1.79 before treatment and 0.47 during treatment. In conclusion, adult doses of subcutaneous interferon β-1a (44 and 22 μg, 3 times weekly) were well tolerated in pediatric patients and were associated with reduced relapse rates. [ABSTRACT FROM PUBLISHER]

Children and adolescents with multiple sclerosis (MS) are reported to show high rates of relapse early in the course of the disease as well as cognitive deterioration over time. Immunomodulatory therapies developed for adult MS patients are currently the standard first-line agents for most paediatric MS patients. Available data indicate that the three interferon-beta preparations and glatiramer acetate are safe and well tolerated in children and adolescents with MS, and provide preliminary indications of efficacy in terms of relapse rate reduction. However, these treatments are only partly effective and their routes of administration can be bothersome, particularly for children. Emerging therapies for MS offer promise for improved disease control and long-term clinical outcome, with the advantage of an oral administration for some of them. The future approval of these new medications requires clinical trial consideration of such therapies in the paediatric population. Many of these new agents carry a higher risk for serious adverse events with increased toxicity and still undefined long-term side effects. There are ethical issues as well as issues related to feasibility that must be borne in mind when planning investigation trials for new pharmacological agents in the paediatric population, including immunological maturity, key period of exposure to numerous community-acquired infections, neurodevelopmental factors, in addition to short-term and long-term age-related toxicities. Furthermore, the lack of a large enough paediatric MS population worldwide limits some designs and the feasibility of participation in all the studies. Emerging new therapies have the potential to optimize the care of both paediatric and adult patients with MS. Future treatment trials in children and adolescents with MS will require a multicentre design, definition and selection of key outcome measures, and identification of the most promising therapies. Risks versus benefits of each specific treatment should be weighed and comprehensively discussed. [ABSTRACT FROM PUBLISHER]

The author discusses acute disseminated encephalomyelitis (ADEM) which is considered an immune-mediated inflammatory demyelinating syndrome of the central nervous system (CNS) affecting young adults and children. She cites on the lack of consensus definitions for ADEM, multiple sclerosis and related disorders in the pediatric population. Also discussed is the high-titer anti-Myelin oligodendrocyte glycoprotein IgG described in children with ADEM, MS, and AQP4- seronegative neuromyelitis optica.