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Acute disseminated encephalomyelitis in children
S N Krishna Murthy1, Howard S Faden, Michael E Cohen
1Department of Neurology, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, New York, USA.
Pediatrics
|August 8, 2002
Summary
Acute disseminated encephalomyelitis (ADEM) in children often follows respiratory infections in winter/spring. While most children recover well with treatment, some experience long-term effects, necessitating differentiation from multiple sclerosis.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neuroimmunology
Background:
- Acute disseminated encephalomyelitis (ADEM) is an immune-mediated demyelinating disease affecting the central nervous system.
- Understanding the epidemiology, clinical presentation, and outcomes of ADEM in children is crucial for diagnosis and management.
Purpose of the Study:
- To characterize the epidemiologic, clinical, neuroimaging, and laboratory features of pediatric ADEM.
- To evaluate treatment strategies and patient outcomes in a cohort of children diagnosed with ADEM.
Main Methods:
- Retrospective chart review of pediatric patients diagnosed with ADEM over a 6-year period.
- Analysis of clinical presentation, laboratory findings, neuroimaging results (MRI), treatment interventions, and patient outcomes.
Main Results:
- Eighteen pediatric ADEM cases were identified, predominantly presenting in winter/spring, often following upper respiratory tract infections.
- Motor deficits and altered consciousness were common presenting symptoms; MRI revealed widespread white matter lesions. Microbiological diagnoses were challenging to establish.
- All patients survived, with 17% experiencing long-term neurologic sequelae. Corticosteroids and IVIG were used for treatment.
Conclusions:
- Epidemiological data suggest a viral infectious etiology for ADEM, likely a respiratory virus.
- Magnetic resonance imaging is the preferred neuroimaging modality for ADEM diagnosis and monitoring.
- The prognosis for survival is excellent, but differentiating recurrent ADEM from multiple sclerosis is important.