Contemporary picture of nervous system disorders in antiphospholipid syndrome in children. Thrombotic manifestat ions: issues of diagnosis, path ogenesis, clinical picture and treatment

Antiphospholipid syndrome is an acquired autoimmune thrombophilia, the main diagnostic criteria of which is vascular thrombosis and/or pregnancy pathology arising due to the presence of antiphospholipid antibodies. Thrombosis in antiphospholipid syndrome can occur in vessels of any caliber and localization, which would explain the significant variability of its clinical manifestations. Ischemic stroke and other types of cerebral thrombosis are a characteristic manifestation of antiphospholipid syndrome and can occur in patients of any age, starting from the neonatal period. The pathogenetic mechanisms of various neuropsychic syndrome development in antiphospholipid syndrome are complex and not completely deciphered. It is believed that in addition to thrombosis itself, some patients have vasculopathy due to pronounced intimal hyperplasia. Besides, there might be a possibility of direct interaction of antiphospholipid antibodies with antigens of various cells of the nervous system.
At present, vitamin K antagonists, heparins and aspirin, still have the same leading role in the treatment of antiphospholipid syndrome, but the difficulties of monitoring point to the need for the
introduction of new oral anticoagulants and antiplatelets. At the same time, the formation of insights about the multifactorial nature of antiphospholipid syndrome shapes the prospects for the use of drugs of other classes: statins, biological agents, complement inhibitors, etc. Features of the hemostasis and immunity system at different periods of childhood, incomplete formation of the central nervous system, the absence of traditional thrombotic risk factors such as atherosclerosis, hypertension, smoking, obesity, the use of oral contraceptives, etc. in most children point out to the
differences of antiphospholipid syndrome in children and adults. This review is devoted to the clinical realities, the course of thrombotic manifestations, primary and secondary antithrombotic preventive measures, and treatment of antiphospholipid syndrome in children. We have analyzed a large volume of literature with a particular focus on contemporary understanding of thrombosis and aniphospholipid syndrome, leading to the formation of neuropsychiatric pathology.