Clinical and diagnostic aspects of multiple sclerosis and acute monophasic encephalomyelitis in pediatric patients: a single centre prospective study.
OBJECTIVE
The purpose of the study was to compare and contrast the initial presenting demographic, clinical, neuroimaging, and laboratory features in a cohort of children affected from multiple sclerosis (MS) or acute disseminated encephalomyelitis (ADEM).


METHODS
A 12-year prospective study was conducted in 68 pediatric patients (age<or=17 years) who presented with a first episode of central nervous system inflammation suggestive of a demyelinating multifocal pathology. All patients had undergone magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) examination. The mean follow-up period, as at ending on December 31, 2007, was 6.8+/-2.7 years (range 3.2-12.6 years).


RESULTS
At clinical onset, children who developed MS during the follow-up (48 patients; 34 females, 14 males; mean age at onset: 14.4+/-2.5) significantly differed from children affected by ADEM (20 patients; 8 females, 12 males; mean age at onset: 8.1+/-3.8) for the following parameters: prevalence of females affected (female/male ratio: 2.8 versus 0.6, P=0.03); mean age at onset (P<0.001); monosymptomatic onset (73% vs 30%, P=0.002); encephalopathy-like onset (0% vs 50%, P<0.001); presence of oligoclonal IgG bands (IgGOB) in CSF (83% vs 10%, P<0.001); and periventricular (79% vs 20%, P<0.001), brain stem (12.5% vs 60%, P=0.000), and basal ganglia (10% vs 50%, P<0.001) lesions at MRI.


CONCLUSIONS
Our findings depict a pattern of demographic, clinical, neuroimaging, and laboratory findings that can help to distinguish, at clinical onset, children suffering from ADEM from those who will develop MS. Childhood-onset MS seems not to differ from adult-onset MS from both clinical and paraclinical features.
Atzori
M
M
Multiple Sclerosis Centre of The Veneto Region, First Neurology Clinic, Department of Pediatrics, University of Padova, and Department of Neuroscience, University Hospital of Padova, Padova, Italy. matteo.atzori@unipd.it
Battistella
P A
PA
Perini
P
P
Calabrese
M
M
Fontanin
M
M
Laverda
A M
AM
Suppiej
A
A
Drigo
P
P
Grossi
P
P
Rinaldi
L
L
Gallo
P
P
D000293:Adolescent; D017677:Age Distribution; D001921:Brain / Q000473:pathology; D002648:Child; D003937:Diagnosis, Differential; D004673:Encephalomyelitis, Acute Disseminated / Q000453:epidemiology* / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000134:cerebrospinal fluid; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D009103:Multiple Sclerosis / Q000453:epidemiology* / Q000473:pathology*; D016011:Normal Distribution; D015995:Prevalence; D011446:Prospective Studies
D007074:Immunoglobulin G