Paediatric multiple sclerosis (MS) is associated with higher relapse rate, rapid magnetic resonance imaging lesion accrual early in the disease course and worse cognitive outcome and physical disability in the long term compared to adult-onset disease. Current treatment strategies are largely centre-specific and reliant on adult protocols. The aim of this review is to examine which treatment options should be considered first line for paediatric MS and we attempt to answer the question if injectable first-line disease-modifying therapies (DMTs) are still an optimal option. To answer this question, we review the effects of early onset disease on clinical course and outcomes, with specific considerations on risks and benefits of treatments for paediatric MS. Considering the impact of disease activity on brain atrophy, cognitive impairment and development of secondary progressive MS at a younger age, we would recommend treating paediatric MS as a highly active disease, favouring the early use of highly effective DMTs rather than injectable DMTs.

中文翻译：

---

一线治疗对当前时代的小儿多发性硬化症意味着什么？

与成人发病的疾病相比，小儿多发性硬化症 (MS) 与较高的复发率、病程早期快速磁共振成像病变积累以及长期较差的认知结果和身体残疾有关。目前的治疗策略主要是针对特定中心的，并且依赖于成人方案。本综述的目的是检查哪些治疗方案应被视为儿科 MS 的一线治疗方案，我们试图回答注射一线疾病改善疗法 (DMT) 是否仍是最佳选择的问题。为了回答这个问题，我们回顾了早发性疾病对临床过程和结果的影响，并具体考虑了儿童 MS 治疗的风险和益处。考虑到疾病活动对脑萎缩的影响，