title: Long-Term Neurocognitive, Psychosocial, and Magnetic Resonance Imaging Outcomes in Pediatric-Onset Acute Disseminated Encephalomyelitis.
abstract: BACKGROUND
  Acute disseminated encephalomyelitis (ADEM) is a demyelinating disorder that is usually self-limited. Recent studies have suggested ongoing neurological deficits and neurocognitive impairment in these patients. Little information on the correlation of clinical and neuroimaging markers in ADEM is available. We examined potential clinical factors (e.g., age of onset, acute symptom duration, magnetic resonance imaging [MRI] lesions) and their relation to neurocognitive and psychosocial outcomes.
  
  
  METHODS
  This is a retrospective chart review of consecutive pediatric patients diagnosed with ADEM between 2006 and 2012. Patients were evaluated with standard neurological assessment, MRI of the brain, and neuropsychological evaluation.
  
  
  RESULTS
  Twenty-three patients with ADEM with average age at neuropsychological assessment of 10.1 years (±3.50) were included. Five (22.7%) patients were impaired on three or more neurocognitive measures. Psychosocial problems were reported in 20%-40% of patients. Earlier age of onset was correlated with poorer sustained attention and psychosocial problems, whereas acute symptom duration and Expanded Disability Status Scale were not. MRI outcomes were correlated with psychosocial outcomes but not neuropsychological findings.
  
  
  CONCLUSIONS
  Our findings suggest lingering cognitive and psychosocial deficits in children with a history of ADEM. Clinical features and MRI findings correlated more strongly with psychosocial outcomes than cognitive functioning. Further studies are needed to confirm relationships and other possible contributing factors to lingering deficits.
authors.affiliation: Division of Pediatric Neurology, Department of Neurology, University at Buffalo, Women & Children's Hospital of Buffalo, Buffalo, New York.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Beatty
authors.affiliation: Department of Neurology, University at Buffalo, Buffalo, New York.
authors.forename: Rachael A
authors.initials: RA
authors.lastname: Bowler
authors.affiliation: Division of Pediatric Neurology, Department of Neurology, University at Buffalo, Women & Children's Hospital of Buffalo, Buffalo, New York.
authors.forename: Osman
authors.initials: O
authors.lastname: Farooq
authors.affiliation: Division of Pediatric Neurology, Department of Neurology, University at Buffalo, Women & Children's Hospital of Buffalo, Buffalo, New York.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Dudeck
authors.affiliation: Department of Neurology, Buffalo Neuroimaging Analysis Center, Buffalo, New York.
authors.forename: Deepa
authors.initials: D
authors.lastname: Ramasamy
authors.affiliation: Department of Neurology, Sick Kids Hospital, Toronto, Canada.
authors.forename: E Ann
authors.initials: EA
authors.lastname: Yeh
authors.affiliation: Department of Neurology, Buffalo Neuroimaging Analysis Center, Buffalo, New York.
authors.forename: Robert
authors.initials: R
authors.lastname: Zivadinov
authors.affiliation: Department of Neurology, University at Buffalo, Buffalo, New York.
authors.forename: Bianca
authors.initials: B
authors.lastname: Weinstock-Guttman
authors.affiliation: Department of Neurology, University at Buffalo, Buffalo, New York. Electronic address: jparrish@buffalo.edu.
authors.forename: Joy B
authors.initials: JB
authors.lastname: Parrish
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000209:etiology*; D004673:Encephalomyelitis, Acute Disseminated / Q000150:complications* / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D012920:Social Behavior Disorders / Q000175:diagnosis / Q000209:etiology*
keywords: age of onset; cognition; demyelinating diseases; depression; fatigue; seizure