Acute disseminated encephalomyelitis in children: outcome and prognosis.
BACKGROUND
Acute disseminated encephalomyelitis (ADEM) is the most common demyelinating disorder of childhood. Its clinical features, prognosis and treatment vary in different reports.


OBJECTIVE
To examine a series of children with ADEM for clinical findings, course, recurrences, and possible variables affecting outcome.


METHODS
Multicentric data collected from 7 tertiary referral centers were registered and evaluated in a central database in 1990 - 2001 for clinical, laboratory, and MRI features. Course and prognosis were assessed in patients with at least 12 months' follow-up.


RESULTS
Forty-six patients were evaluated. Median age at onset was 8 years, M/F ratio, 1.7/1. Most common symptoms and signs pertained to the motor system and consciousness. Of 39 children with 12 months' follow-up, 71 % recovered completely. Thirteen (33 %) children had relapses. Patients who had more than one relapse (n = 4) presented with new symptoms at each attack. Treatment with high-dose methylprednisolone was associated with complete recovery, and tapering over more than 3 weeks, with a lower rate of relapses. MRI lesions could persist even in asymptomatic patients; in particular, periventricular lesions tended to disappear later than others.


CONCLUSIONS
Complete clinical recovery is common and serious complications are rare in childhood ADEM, but the rate of relapses is considerable. Clinical picture at first relapse may help to identify patients likely to experience multiple relapses. The timing and duration of steroid treatment affects outcome.
Anlar
B
B
Hacettepe University Department of Pediatric Neurology, Ankara, Turkey. banlar@hacettepe.edu.tr
Basaran
C
C
Kose
G
G
Guven
A
A
Haspolat
S
S
Yakut
A
A
Serdaroglu
A
A
Senbil
N
N
Tan
H
H
Karaagaoglu
E
E
Karli Oguz
K
K
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004673:Encephalomyelitis, Acute Disseminated / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D020127:Recovery of Function / Q000502:physiology; D012008:Recurrence; D012720:Severity of Illness Index; D013997:Time Factors