title: [Acute disseminated encephalomyelitis in Tunisia: Report of a pediatric cohort].
abstract: BACKGROUND
  Acute disseminated encephalomyelitis (ADEM) is an inflammatory, demyelinating disorder of the central nervous system whose clinical features, management and outcome are incompletely understood in Tunisian population.
  
  
  OBJECTIVE
  To describe clinical, neuroimaging and laboratory features; treatment and outcome in a cohort of Tunisian children with ADEM.
  
  
  METHODS
  We conducted a retrospective review of the medical records of all children attending the Department of Child and Adolescent Neurology (Tunis) with ADEM between 2005 and 2015. Clinical, neuroimaging and laboratory features, therapeutic data and outcome were analyzed.
  
  
  RESULTS
  There were 15 children (7 males and 8 females). The mean age at onset was 6.9 years. Thirteen (86.6%) patients had a prodromal event. The onset of neurological symptoms occurred within 17.6 days (4-30). Limb weakness was the most common presenting symptom (53.3%). Extrapyramidal syndrome was noticed in 6 patients (40%). Initial MRI showed a deep gray matter involvement in 7 cases (46.6%). Gadolinium enhancement at acute stage was observed in only 2 patients (13%). Cerebrospinal fluid findings did not show intrathecal oligoclonal bands. The use of high-dose IV methylprednisolone followed by oral steroid taper was associated with rapid recovery. Additional treatment with intravenous immunoglobulin was necessary in 2 patients. Complete recovery was obtained in 11 patients (73.3%). A monophasic course was noticed in 14 cases. Only one patient (5%) developed multiple sclerosis.
  
  
  CONCLUSIONS
  The high frequency of prodromal events and extrapyramidal syndrome in addition to the low rate of gadolinium enhancement at acute stage seem to be the main features in our patients. Larger ADEM multicenter cohort studies in Tunisia and North Africa could provide more detailed information about this entity.
authors.affiliation: UR12SP24 et service de neurologie de l'enfant et de l'adolescent, Institut national Mongi Ben Hmida de neurologie, La Rabta, 1007 Tunis, Tunisie. Electronic address: nediaachour@yahoo.fr.
authors.forename: N
authors.initials: N
authors.lastname: Ben Achour
authors.affiliation: UR12SP24 et service de neurologie de l'enfant et de l'adolescent, Institut national Mongi Ben Hmida de neurologie, La Rabta, 1007 Tunis, Tunisie.
authors.forename: O
authors.initials: O
authors.lastname: Ben Waddey
authors.affiliation: UR12SP24 et service de neurologie de l'enfant et de l'adolescent, Institut national Mongi Ben Hmida de neurologie, La Rabta, 1007 Tunis, Tunisie.
authors.forename: I
authors.initials: I
authors.lastname: Kraoua
authors.affiliation: UR12SP24 et service de neurologie de l'enfant et de l'adolescent, Institut national Mongi Ben Hmida de neurologie, La Rabta, 1007 Tunis, Tunisie.
authors.forename: H
authors.initials: H
authors.lastname: Benrhouma
authors.affiliation: UR12SP24 et service de neurologie de l'enfant et de l'adolescent, Institut national Mongi Ben Hmida de neurologie, La Rabta, 1007 Tunis, Tunisie.
authors.forename: H
authors.initials: H
authors.lastname: Klaa
authors.affiliation: UR12SP24 et service de neurologie de l'enfant et de l'adolescent, Institut national Mongi Ben Hmida de neurologie, La Rabta, 1007 Tunis, Tunisie.
authors.forename: A
authors.initials: A
authors.lastname: Rouissi
authors.affiliation: UR12SP24 et service de neurologie de l'enfant et de l'adolescent, Institut national Mongi Ben Hmida de neurologie, La Rabta, 1007 Tunis, Tunisie.
authors.forename: I
authors.initials: I
authors.lastname: Ben Youssef-Turki
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001480:Basal Ganglia Diseases / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004673:Encephalomyelitis, Acute Disseminated / Q000150:complications / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007223:Infant; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D009103:Multiple Sclerosis / Q000209:etiology; D043025:Oligoclonal Bands; D012189:Retrospective Studies; D016896:Treatment Outcome; D014416:Tunisia
chemical_list: D000893:Anti-Inflammatory Agents; D016756:Immunoglobulins, Intravenous; D043025:Oligoclonal Bands; D008775:Methylprednisolone
keywords: Acute disseminated encephalomyelitis; Auto-immune diseases; Children; Encéphalomyélite aiguë disséminée; Enfants; Maladies auto-immunes; Postinfectieux; Postinfectious