title: Acute disseminated encephalomyelitis that meets modified McDonald criteria for dissemination in space is associated with a high probability of conversion to multiple sclerosis in Taiwanese patients.
abstract: BACKGROUND
  Patients with acute disseminated encephalomyelitis (ADEM) may relapse and some may ultimately convert to multiple sclerosis (MS); however, no criteria that can predict MS conversion are available to date. Our aim was to describe the clinical and magnetic resonance imaging (MRI) features of patients with an initial ADEM attack and evaluate which MRI criteria can predict conversion to MS.
  
  
  METHODS
  We retrospectively reviewed the records of 36 patients diagnosed with ADEM. We determined clinical signs/symptoms, examined the cerebrospinal fluid (CSF), and performed brain MRI scans and compared the findings between patients who did and did not convert to MS.
  
  
  RESULTS
  Clinical signs/symptoms, and CSF analysis show no significant difference between the two groups. The rate of conversion to MS from ADEM in Taiwanese patients is low (11%) after a mean follow-up period of 28.36 months. Modified McDonald criteria were fulfilled in 19/36 patients: 21% (4/19) of those patients developed MS according to Poser criteria subsequently. Of the other patients (17/36) who did not fulfill these criteria, none converted to MS. (log rank test; P=0.027).
  
  
  CONCLUSIONS
  It is difficult to predict from initial clinical presentations to address which patients with ADEM will convert to MS. Patients with ADEM whose brain MRI findings met the modified McDonald criteria may have clinically isolated syndrome because they have a significantly higher probability of conversion to MS. In contrast, patients whose brain MRI findings did not meeting these criteria may be considered as having classic ADEM because they have a lower probability of conversion to MS.
authors.affiliation: Department of Neurology.
authors.forename: M F
authors.initials: MF
authors.lastname: Liao
authors.affiliation: Department of Neurology.
authors.forename: C C
authors.initials: CC
authors.lastname: Huang
authors.affiliation: Department of Neurology.
authors.forename: R K
authors.initials: RK
authors.lastname: Lyu
authors.affiliation: Department of Neurology.
authors.forename: C M
authors.initials: CM
authors.lastname: Chen
authors.affiliation: Department of Neurology.
authors.forename: H S
authors.initials: HS
authors.lastname: Chang
authors.affiliation: Department of Neurology.
authors.forename: C-C
authors.initials: CC
authors.lastname: Chu
authors.affiliation: Department of Neurology.
authors.forename: W C
authors.initials: WC
authors.lastname: Hsu
authors.affiliation: Department of Neurology.
authors.forename: Y R
authors.initials: YR
authors.lastname: Wu
authors.affiliation: Department of Neurology.
authors.forename: H C
authors.initials: HC
authors.lastname: Kuo
authors.affiliation: Department of Neurology.
authors.forename: M Y
authors.initials: MY
authors.lastname: Cheng
authors.affiliation: Division of Pediatric Neurology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang-Gung University, Taipei, Taiwan.
authors.forename: P C
authors.initials: PC
authors.lastname: Hung
authors.affiliation: Division of Pediatric Neurology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang-Gung University, Taipei, Taiwan.
authors.forename: M L
authors.initials: ML
authors.lastname: Chou
authors.affiliation: Division of Pediatric Neurology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang-Gung University, Taipei, Taiwan.
authors.forename: K L
authors.initials: KL
authors.lastname: Lin
authors.affiliation: Division of Pediatric Neurology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang-Gung University, Taipei, Taiwan.
authors.forename: M Y
authors.initials: MY
authors.lastname: Hsieh
authors.affiliation: Department of Neurology.
authors.forename: L S
authors.initials: LS
authors.lastname: Ro
mesh_terms: D000328:Adult; D002675:Child, Preschool; D018450:Disease Progression; D004673:Encephalomyelitis, Acute Disseminated / Q000150:complications* / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000209:etiology* / Q000473:pathology*; D012189:Retrospective Studies; D013624:Taiwan