title: Recovery From Central Nervous System Acute Demyelination in Children.
abstract: BACKGROUND
  Few prospective studies have systematically evaluated the extent of recovery from incident acquired demyelinating syndromes (ADS) of the central nervous system in children.
  
  
  METHODS
  In a national cohort study of pediatric ADS, severity of the incident attack and extent of recovery by 12 months were evaluated. Annual evaluations were used to determine current diagnoses (monophasic ADS or multiple sclerosis [MS]) and new deficits.
  
  
  RESULTS
  Of 283 children, 244 (86%) required hospitalization for a median (interquartile range [IQR]) of 6 (3-10) days, and 184 had moderate or severe deficits; 41 children were profoundly encephalopathic, 129 were unable to ambulate independently, and 59 with optic neuritis (ON) had moderately or severely impaired vision. Those with transverse myelitis (TM) and patients with monophasic disease were more likely to have moderate or severe deficits at onset. Twenty-seven children (10%) did not experience full neurologic recovery from their incident attack; 12 have severe residual deficits. Monophasic illness, TM, and moderate or severe deficits at onset were associated with poor recovery. After a median (IQR) follow-up of 5.06 (3.41-6.97) years, 59 children (21%) were diagnosed with MS; all recovered fully from their incident ADS attacks, although 6 subsequently acquired irreversible deficits after a median (IQR) observation period of 5.93 (4.01-7.02) years.
  
  
  CONCLUSIONS
  ADS is a serious illness, with 86% of affected Canadian children requiring hospitalization. More than 90% of children recovered physically from their ADS event, including those children experiencing onset of MS. However, permanent visual or spinal cord impairment occurred in some children with ON or TM.
authors.affiliation: Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; The Hospital for Sick Children, Toronto, Ontario, Canada; julia.omahony@mail.utoronto.ca.
authors.forename: Julia
authors.initials: J
authors.lastname: O'Mahony
authors.affiliation: Department of Internal Medicine, Winnipeg Health Sciences Center, University of Manitoba, Winnipeg, Manitoba, Canada;
authors.forename: Ruth Ann
authors.initials: RA
authors.lastname: Marrie
authors.affiliation: Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada;
authors.forename: Audrey
authors.initials: A
authors.lastname: Laporte
authors.affiliation: Division of Neurology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada;
authors.forename: E Ann
authors.initials: EA
authors.lastname: Yeh
authors.affiliation: Neuroimmunology Unit, Montreal Neurologic Institute and Hospital, McGill University, Montreal, Quebec, Canada; Experimental Therapeutics Program, Montreal Neurologic Institute and Hospital, McGill University, Montreal, Quebec, Canada;
authors.forename: Amit
authors.initials: A
authors.lastname: Bar-Or
authors.affiliation: The Hospital for Sick Children, Toronto, Ontario, Canada;
authors.forename: Cathy
authors.initials: C
authors.lastname: Phan
authors.affiliation: Janeway Children's Health and Rehabilitation Centre, St John's, Newfoundland, Canada;
authors.forename: David
authors.initials: D
authors.lastname: Buckley
authors.affiliation: Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada;
authors.forename: David
authors.initials: D
authors.lastname: Callen
authors.affiliation: Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada;
authors.forename: Mary B
authors.initials: MB
authors.lastname: Connolly
authors.affiliation: Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada;
authors.forename: Daniela
authors.initials: D
authors.lastname: Pohl
authors.affiliation: Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada;
authors.forename: Marie-Emmanuelle
authors.initials: ME
authors.lastname: Dilenge
authors.affiliation: Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada;
authors.forename: Geneviève
authors.initials: G
authors.lastname: Bernard
authors.affiliation: Department of Pediatrics, Université de Montreal, Montreal, Quebec, Canada;
authors.forename: Anne
authors.initials: A
authors.lastname: Lortie
authors.affiliation: Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada;
authors.forename: Noel
authors.initials: N
authors.lastname: Lowry
authors.affiliation: Department of Pediatrics, Queen's University, Kingston, Ontario, Canada;
authors.forename: E Athen
authors.initials: EA
authors.lastname: MacDonald
authors.affiliation: Department of Pediatrics, Saint John Regional Hospital, Saint John, New Brunswick, Canada;
authors.forename: David
authors.initials: D
authors.lastname: Meek
authors.affiliation: Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada;
authors.forename: Guillaume
authors.initials: G
authors.lastname: Sébire
authors.affiliation: Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada;
authors.forename: Sunita
authors.initials: S
authors.lastname: Venkateswaran
authors.affiliation: Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada;
authors.forename: Ellen
authors.initials: E
authors.lastname: Wood
authors.affiliation: Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada; and.
authors.forename: Jerome
authors.initials: J
authors.lastname: Yager
authors.affiliation: The Hospital for Sick Children, Toronto, Ontario, Canada; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Brenda
authors.initials: B
authors.lastname: Banwell
mesh_terms: D002490:Central Nervous System / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D020278:Demyelinating Autoimmune Diseases, CNS / Q000175:diagnosis* / Q000503:physiopathology; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies