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Acute disseminated encephalomyelitis: a 10-year cohort study in Thai children

Anannit Visudtibhan1, Lochana Tuntiyathorn, Jarin Vaewpanich

  • 1Division of Neurology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama 6 Road, Rajchathewee, Bangkok 10400, Thailand. raavs@mahidol.ac.th

European Journal of Paediatric Neurology : EJPN : Official Journal of the European Paediatric Neurology Society
|March 31, 2010
PubMed

Insights

Childhood acute disseminated encephalomyelitis (ADEM) can evolve into multiple sclerosis in Asian children. Most Thai children with ADEM experienced complete recovery, showing similar outcomes to Western studies.

Area of Science:

  • Pediatric Neurology
  • Demyelinating Diseases
  • Neuroimmunology

Background:

  • Childhood acute disseminated encephalomyelitis (ADEM) is a rare, immune-mediated demyelinating disease.
  • The long-term evolution of ADEM to multiple sclerosis (MS) in Asian pediatric populations remains under-investigated.

Purpose of the Study:

  • To investigate the clinical course, outcomes, and potential evolution to multiple sclerosis in Thai children diagnosed with ADEM.
  • To compare ADEM outcomes in Thai children with findings from Western studies.

Main Methods:

  • Retrospective review of medical records, investigations, and brain MRI for Thai children (<15 years) diagnosed with ADEM (1997-2006).
  • Longitudinal follow-up (2-10 years) using interviews, questionnaires, and neurological exams to assess clinical course and disability (Modified Rankin Score).
  • MRI findings (T2-weight, FLAIR) were categorized by location and number of lesions.

Main Results:

  • 16 Thai children (5 boys, 11 girls; age 1-14 years) were identified with ADEM.
  • Nine patients had cranial nerve dysfunction; one died with confirmed ADEM.
  • Of 15 followed, 13 had monophasic ADEM (10 fully recovered) and 3 developed multiple sclerosis.
  • No association found between initial MRI lesion characteristics and outcome/diagnosis.

Conclusions:

  • Childhood ADEM in Thai children presents similarly and has comparable outcomes to those reported in Western countries.
  • ADEM can occasionally evolve into multiple sclerosis in Thai children, consistent with reports from other Asian regions.
  • Early ADEM diagnosis and management are crucial for pediatric patients.

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