単相急性分散型脳炎の小児患者における中長期の障害および機能的アウトカム
Lorna Stemberger Marić1, Vladimir Trkulja2, Andrea Nikčević3
1University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Mirogojska 8, 10000, Zagreb, Croatia; University of Zagreb, School of Medicine, Šalata 3, 10000, Zagreb, Croatia.
まとめ
発散性急性脳内炎 (ADEM) のほとんどの子どもは回復し,重度の初期症状は必ずしも長期的障害を予知するものではありません. 回復した子どもはADEMの軽度で持続的な影響を受けることがあります.
科学分野:
- 小児神経学
- 神経免疫学
- 脱エリン化 する 病気
背景:
- 発散性急性脳炎 (ADEM) は珍しい神経疾患である.
- ADEMは脳病変,多焦点症状,そして脱ミエリン症候群で表れます.
- 予後はしばしば好ましいが,長期的な神経心理学的および運動的欠陥が発生することがあります.
研究 の 目的:
- 急性単相性ADEMの特徴と患者のアウトカムとの関連を評価する.
- ADEM後の即時および長期の障害と機能状態を評価する.
- 子供のADEMの予知要因を特定する.
主な方法:
- 18歳以上の単相性ADEMの子供の逆行図のレビュー
- フォローアップ評価には,医療的,神経学的,機能的な結果評価が含まれていました.
- 障害の評価のために修正されたランキンスケール (mRS) とEDSS-FSSを使用した.
主要な成果:
- 65人の子供のうち61. 5%が続発症し,2人は重度の眼/皮質症状を発症した.
- 41人の子どもを長期追跡 (中位154ヶ月) したところ,14人の子どもには後遺症が見られた.
- 後遺症のほとんどは最小限の障害 (mRS 0-1, EDSS- FSS 0-3) であったが,重度の後遺症の2人は著しい認知機能低下を示した.
結論:
- 重度の急性ADEMエピソードは,一貫して長期的な機能的欠陥を予測するものではありません.
- ADEMから回復している子どもは 微妙で持続的な症状を経験するかもしれません
- 早期のADEMの重症度は 長期的な障害の信頼できる指標ではありません
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