Modern therapy possibilities of cognitive disorders in children with demyelination diseases of central nervous system
PEDIATRICS
Abstract
In recent years, there has been a significant increase in the number of adolescents aged 12–18 years with demyelinating diseases of the central nervous system (MS onset). Despite the short duration of the disease, they actively complain of cognitive decline (memory, decreased concentration, inability to maintain attention for long periods). We collect, systematize and analyze modern literature on the problem of cognitive impairment in children with various demyelinating diseases of the central nervous system, identify trends and determine the tactics of cognitive neurorehabilitation.Specialized electronic resources —e LIBRARY, Pub Med, Scopus,and Cyber Leninka — were used to obtain the necessary information and search for literature sources. We collected, systematized, and analyzed current literature from 2015–2025 on cognitive impairment in children with variouscentral nervous systemdisorders: acute disseminated encephalomyelitis, neuromyelitis optica spectrum disorder, myelin oligodendrocyte glycoprotein antibody-associated disease, and multiple sclerosis.The article describes the key components of the pathogenesis of cognitive impairment in various demyelinating diseases of the central nervous system, including immune-mediated destruction of the myelin sheath, demyelination of nerve fibers, and axonal damage in neural networks, which impairs the proper implementation of higher cortical functions. It has been noted that the frequency and nature of cognitive impairment in children depends on the characteristics of the demyelinating diseases of the central nervous system.A cognitive neurorehabilitation tactic is proposed, including the early use of a neuropeptide drug with a complex effect and a non-invasive route of administration of methionyl-glutamyl-histidyl-phenylalanyl-prolyl-glycyl-proline.Early detection of cognitive deficits, their correction using methionyl-glutamyl-histidyl-phenylalanyl-prolyl-glycyl-proline, a complex neuropeptide drug with a non-invasive route of administration, neuropsychological rehabilitation, and optimal immunotherapy aimed at reducing inflammatory activity are important components of the management strategy for children with demyelinating diseases of the central nervous system to improve the long-term prognosis.
References
1. Tarantino S., Proietti Checchi M., Papetti L. et al. Neuropsychological performances, quality of life, and psychological issues in pediatric onset multiple sclerosis: a narrative review. Neurol Sci. 2024;45(5):1913–1930. https://doi.org/10.1007/s10072-023-07281-y.
2. O’Neill K.A., Charvet L., Waltz M. et al. Cognitive function in people with pediatric multiple sclerosis over 2 years. Neurology. 2025;105(8):e214142. https://doi.org/10.1212/WNL.0000000000214142.
3. Жуйкова С.Е. Физиологические и клинические эффекты синтетического аналога АКТГ 4-10 Семакса и его механизмы действия. Интегративная физиология. 2022;3(2):204–220. https://doi.org/10.33910/2687-1270-2022-3-2-204-220.
4. Быстрицкая Е.И., Ширяев О.Ю., Неретина А.Ф. Исследование влияния Семакса на показатели сенсорно-перцептивной сферы детей, страдающих церебральным параличом. Научно-медицинский вестник Центрального Черноземья. 2003;(1):33–38. EDN: ZFPPGN.
5. Takahashi Y., Hayakawa I., Abe Y. Diagnostic odyssey of acute disseminated encephalomyelitis in children. Sci Rep. 2021;11(1):21954. https://doi.org/10.1038/s41598-021-01519-5.
6. Чередниченко О.А., Карнаух В.Н. Острый диссеминированный энцефаломиелит. Сибирское медицинское обозрение. 2019;(6):15–23. https://doi.org/10.20333/2500136-2019-6-15-23.
7. Скрипченко Н.В., Иванова Г.П., Скрипченко Е.Ю. и др. Демиелинизирующие заболевания нервной системы у детей. Ю.В. Лобзин, А.А. Скоромец, ред. М.: Комментарий; 2016. 352 с.
8. Нейроинфекции у детей. Н.В. Скрипченко, ред. СПб.: Тактик-Студио; 2015. 856 с.
9. Kong L., Lang Y., Wang X. et al. Identifying different cognitive phenotypes and their relationship with disability in neuromyelitis optica spectrum disorder. Front Neurol. 2022;13:958441. https://doi.org/10.3389/fneur.2022.958441.
10. Kazzi C., Alpitsis R., O’Brien T.J., Malpas C., Monif M. Cognitive and psychopathological outcomes in acute disseminated encephalomyelitis. BMJ Neurol Open. 2024;6(1):e000640. https://doi.org/10.1136/bmjno-2024-000640.
11. Cera N., Pinto J., Faustino R. Functional and structural alterations in pediatric multiple sclerosis: a systematic review and a preliminary activation likelihood estimation functional magnetic resonance imaging meta-analysis. Pediatr Rep. 2025;17(3):57. https://doi.org/10.3390/pediatric17030057.
12. Алифирова В.М., Титова М.А., Мусина Н.Ф., Жукова И.А. Демиелинизирующие заболевания центральной нервной системы. Томск: Изд-во Сиб ГМУ; 2020. 111 с.
13. Лукашевич И.П., Парцалис Е.М., Шкловский В.М. Перинатальные факторы риска формирования патологии речи у детей. Российский вестник перинатологии и педиатрии. 2008;53(4):19–22. EDN: JUAQHH.
14. Железникова Г.Ф., Скрипченко Н.В., Иванова Г.П., Суровцева А.В., Монахова Н.Е. Цитокины и герпесвирусы при рассеянном склерозе у детей. Инфекция и иммунитет. 2015;5(4):349–358. EDN: VIZEMJ.
15. Скрипченко Н.В., Суровцева А.В., Иванова Г.П., Железникова Г.Ф. Герпесвирусы как причина обострений при рассеянном склерозе у детей. В кн.: Актуальные проблемы неврологии: Материалы 9-й научно-практической конференции неврологов СЗФО РФ с международным участием, Сыктывкар, 31.03–1.04.2016. Киров; 2016. С. 78–83.
16. Nasios G., Bakirtzis C., Messinis L. Cognitive impairment and brain reorganization in MS: underlying mechanisms and the role of neurorehabilitation. Front Neurol. 2020;11:147. https://doi.org/10.3389/fneur.2020.00147.
17. Mittelman A., Pique J., Desportes V. et al. Cognitive and academic outcomes in children with myelin oligodendrocyte glycoprotein antibody-associated disease. Dev Med Child Neurol. 2024;67(4):529–536. https://doi.org/10.1111/dmcn.16093.
18. Charvet L.E., O,Donnell E.H., Belman A.L et al. Longitudinal assessment of cognitive function in pediatric-onset demyelinating diseases. Mult Scler J. 2014;20(11):1502-1510. https://doi.org/10.1177/1352458514527862.
19. Kazzi C., Alpitsis R., O’Brien T.J. et al. Cognitive and psychopathological features of neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein antibody-associated disease: a narrative review. Mult Scler Relat Disord. 2024;85:105596. https://doi.org/10.1016/j.msard.2024.105596.
20. Sechi E., Cacciaguerra L., Chen J.J. et al. Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD): a review of clinical and MRI features, diagnosis, and management. Front Neurol. 2022;13:885218. https://doi.org/10.3389/fneur.2022.885218.
21. Левин О.С. Диагностика и лечение когнитивных нарушений и деменции в клинической практике. М.: МЕДпресс-информ; 2019. 448 с.
22. Llufriu S., Blanco Y., Gómez-Ballesteros R. et al. Cognitive performance and health-related quality of life in patients with neuromyelitis optica spectrum disorder. J Pers Med. 2022;12(5):743. https://doi.org/10.3390/jpm12050743.
23. Автенюк А.С., Макаров И.В., Емелина Д.А., Гасанов Р.Ф., Кравченко И.В., Прохоренко Е.С. Когнитивный дефицит у детей (обзор литературы). Обозрение психиатрии и медицинской психологии имени В.М. Бехтерева. 2022;56(4):8–17. https://doi.org/10.31363/2313-7053-2022-4-8-17.
24. Gordon-Lipkin E., Mealy M.A., Ferenc L. et al. Neuropsychological profiles in pediatric neuromyelitis optica spectrum disorder. Neurology. 2017;88(16):P4.155. https://doi.org/10.1212/WNL.88.16_supplement.P4.155.
25. Parrish J., Farooq O., Weinstock-Guttman B. Cognitive deficits in pediatric-onset multiple sclerosis: what does the future hold? Mult Scler J. 2014;20(10):1286–1294. https://doi.org/10.2217/nmt.14.4.
26. Yeh E.A., Krup L.B., Charvet L.E et al. Fatigue and depression in children with MS and other demyelinating disorders. Neurology. 2016;87(16 Suppl 2):S82–S87. https://doi.org/10.1177/1352458517706038.
27. Waldman A., Ness J., Pohl D. et al. Pediatric multiple sclerosis: clinical features and outcome. Neurology. 2016;87(9):S74-81. https://doi.org/10/1212/WNL.0000000000003028.
28. Portaccio E., Meo E., Bellinvia A. et al. Cognitive reserve in pediatric multiple sclerosis. Neurol Neuroimmunol Neuroinflamm. 2021;8(4):e1005. https://doi.org/10.3390/brainsci11040442.
29. Simone M., Viterbo R.G., Margari L. et al. Attention rehabilitation in pediatric multiple sclerosis: a pilot randomized trial. Brain Sci. 2021;11(5):640. https://doi.org/10.3390/brainsci11050637.
30. Иванова Н.Е. Результаты применения препарата Семакс при когнитивных нарушениях в остром периоде ишемического инсульта и при хронической ишемии мозга. Эффективная фармакотерапия. 2012;(2):8–13. EDN: SLUCET.
31. Страхов В.В., Попова А.А., Федоров В.Н. Результаты исследования нейропротекторной эффективности препарата «Семакс». Офтальмологические ведомости. 2014;7(4):43–51. EDN: THSCJT.
