[Demyelinizing diseases in children. Acute disseminated encephalomyelitis and multiple sclerosis]

Area of Science:

• Pediatric Neurology
• Neuroimmunology
• Demyelinating Diseases

Background:

• Demyelinating diseases of the central nervous system in children present diagnostic challenges.
• Acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) are the primary demyelinating conditions encountered in pediatric populations.
• Accurate differentiation is crucial for appropriate management and prognosis.

Purpose of the Study:

• To review the key characteristics of ADEM and MS in children.
• To highlight the diagnostic criteria and challenges in differentiating these two conditions.
• To emphasize the importance of early and accurate diagnosis in pediatric demyelinating diseases.

Main Methods:

• Review of existing literature on pediatric ADEM and MS.
• Analysis of physiopathological characteristics, etiologies, clinical manifestations, and diagnostic approaches.
• Inclusion of operating definitions from the International Study Group of Multiple Pediatric Sclerosis.

Main Results:

• ADEM is characterized as monophasic, polysymptomatic, with encephalopathy, and lasting up to 3 months with fluctuating symptoms and specific MRI findings.
• MS presents as an isolated monofocal or polyfocal syndrome without encephalopathy.
• Current understanding considers ADEM and MS as distinct diseases from symptom onset.

Conclusions:

• ADEM and MS are distinguishable pediatric demyelinating diseases with unique clinical and diagnostic profiles.
• Diagnostic certainty, especially in younger children, necessitates thorough investigation and adherence to established criteria.
• The distinction between ADEM and MS is critical for guiding treatment strategies and predicting patient outcomes.