Acute disseminated encephalomyelitis in children: focus on relapsing patients.
This study investigated the possible prognostic factors for relapse, and the diagnostic criteria for multiple sclerosis and related disorders, in pediatric acute disseminated encephalomyelitis. The study population comprised 24 Italian children with a mean age at onset of 6.9 years, and a mean follow-up time of 52.8 months (range, 12-180). Clinical, neurophysiologic, spinal-fluid, neuroradiologic, and outcome features were investigated. All patients but 2, who were reclassified as exhibiting clinically isolated syndromes, fulfilled the new classification criteria for acute disseminated encephalomyelitis recently proposed by the International Pediatric Multiple Sclerosis Study Group. Three patients relapsed after 3 months, 2 years, and 8 years, respectively. By the second attack, the diagnosis of multiple sclerosis, as well as of multiphasic disseminated encephalomyelitis, could be rendered using the revised criteria of McDonald et al. Long-term follow-up seemed to confirm a chronic disease course in 2 children. We could not identify features at onset to predict outcomes of patients. However, early in follow-up, the appearance of oligoclonal immunoglobulin G bands in spinal fluid and the persistence of visual-evoked potential abnormalities were associated with poor outcomes.
Department of Pediatrics, University of Padua, Padua, Italy. suppiej@pediatria.unipd.it
Agnese
A
Suppiej
Roberta
R
Vittorini
Marta
M
Fontanin
Domenico
D
De Grandis
Renzo
R
Manara
Matteo
M
Atzori
Paolo
P
Gallo
Pier Antonio
PA
Battistella
D000293:Adolescent; D000328:Adult; D001921:Brain / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004569:Electroencephalography; D004673:Encephalomyelitis, Acute Disseminated / Q000134:cerebrospinal fluid / Q000209:etiology / Q000473:pathology*; D005074:Evoked Potentials, Visual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009103:Multiple Sclerosis / Q000150:complications; D011379:Prognosis; D012008:Recurrence; D013116:Spinal Cord / Q000473:pathology; D016896:Treatment Outcome
D007074:Immunoglobulin G