Factors Related to Long Term Motor, Behavioral, and Scholastic Outcome in Children with Acute Disseminated Encephalomyelitis

Iype, Mary; Anish, Thekkumkara Surendran Nair; Kunju, PA Mohammed; Saradakutty, Geetha; Sreedharan, Mini; Ahamed, Shahanaz M

doi:10.1016/j.pediatrneurol.2018.08.015

Cited by 11 publications

(11 citation statements)

References 21 publications

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“…A significant cohort research revealed that around 10.3% of ADEM patients could present with TDLs ( 34 ). According to research, ADEM patients who present with TDLs often suffer motor or cognitive sequelae, and children who have previously been diagnosed with ADEM may have behavioral problems, seizures, or repeated demyelinating episodes ( 35 ). The majority of ADEM cases were observed in pediatrics because to the age selection bias, and just one patient with ADEM onset with TDLs was gathered in our investigation.…”

Section: Discussionmentioning

confidence: 99%

Central nervous system tumefactive demyelinating lesions: Risk factors of relapse and follow-up observations

Li¹,

Miao²,

Wang³

et al. 2022

Front. Immunol.

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ObjectiveTo track the clinical outcomes in patients who initially presented with tumefactive demyelinating lesions (TDLs), we summarized the clinical characteristics of various etiologies, and identified possible relapse risk factors for TDLs.MethodsBetween 2001 and 2021, 116 patients initially presented with TDLs in our hospital were retrospectively evaluated. Patients were followed for relapse and clinical outcomes, and grouped according to various etiologies. Demographic information, clinical data, imaging data, and laboratory results of patients were obtained and analyzed. The risk factors of relapse were analyzed by the Log-Rank test and the Cox proportional hazard model in multivariate analysis.ResultDuring a median follow-up period of 72 months, 33 patients were diagnosed with multiple sclerosis (MS), 6 patients with Balo, 6 patients with neuromyelitis optica spectrum disorders (NMOSD), 10 patients with myelin oligodendrocyte glycoprotein antibody-associated demyelination (MOGAD), 1 patient with acute disseminated encephalomyelitis (ADEM), and the remaining 60 patients still have no clear etiology. These individuals with an unknown etiology were categorized independently and placed to the other etiology group. In the other etiology group, 13 patients had recurrent demyelinating phases, while 47 patients did not suffer any more clinical events. Approximately 46.6% of TDLs had relapses which were associated with multiple functional system involvement, first-phase Expanded Disability Status Scale score, lesions morphology, number of lesions, and lesions location (P<0.05). And diffuse infiltrative lesions (P=0.003, HR=6.045, 95%CI:1.860-19.652), multiple lesions (P=0.001, HR=3.262, 95%CI:1.654-6.435) and infratentorial involvement (P=0.006, HR=2.289, 95%CI:1.064-3.853) may be independent risk factors for recurrence. Relapse free survival was assessed to be 36 months.ConclusionsIn clinical practice, around 46.6% of TDLs relapsed, with the MS group showing the highest recurrence rate, and lesions location, diffuse infiltrative lesions, and multiple lesions might be independent risk factors for relapse. Nevertheless, despite extensive diagnostic work and long-term follow-up, the etiology of TDLs in some patients was still unclear. And these patients tend to have monophase course and a low rate of relapse.

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Section: Discussionmentioning

confidence: 99%

Central nervous system tumefactive demyelinating lesions: Risk factors of relapse and follow-up observations

Li¹,

Miao²,

Wang³

et al. 2022

Front. Immunol.

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“…A two large series identified that up to 44% of children had attention-deficit hyperactivity disorder, 32% with behavioral problems, and 22% with learning disabilities. 43,44 Risk factors for these clinical phenotypes was more severe neurologic involvement at presentation, older age, and male gender, indicating a likely link with their neuroimmunologic disorder. The etiology of these sequelae is unclear, although two studies have demonstrated diminished brain volume in both the cortex and cerebellum in children with demyelinating events.…”

Section: Prognosismentioning

confidence: 99%

Diagnostic Considerations in Acute Disseminated Encephalomyelitis and the Interface with MOG Antibody

Santoro

Chitnis

2019

Neuropediatrics

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Acute disseminated encephalomyelitis (ADEM) is a common yet clinically heterogenous syndrome characterized by encephalopathy, focal neurologic findings, and abnormal neuroimaging. Differentiating ADEM from other demyelinating disorders of childhood can be difficult and appropriate interpretation of the historical, clinical, and neurodiagnostic components of a patient's presentation is critical. Myelin oligodendrocyte glycoprotein (MOG) antibody-associated diseases are a recently recognized set of disorders, which include ADEM presentations, among other phenotypes. This review article discusses the clinical diagnosis, differential diagnosis, interpretation of data, and treatment/prognosis of this unique syndrome with distinctive review of the spectrum of MOG antibodies.

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“…Children who have ADEM may evolve with motor or cognitive sequela. A recent study described the long-term outcome of 102 children with ADEM [17]. According to this study, 17.2% of the children had long-term motor or motor and sensory deficit and 8% had MRC grade 3 or less power in at least one limb.…”

Section: Discussionmentioning

confidence: 88%

Acute disseminated encephalomyelitis in a COVID-19 pediatric patient

et al. 2020

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The authors present a case of acute disseminated encephalomyelitis in a COVID-19 pediatric patient with positive SARS-CoV2 markers from a nasopharyngeal swab. A previously healthy 12-year-old-girl presented with a skin rash, headache, and fever. Five days after that, she had an acute, progressive, bilateral, and symmetrical motor weakness. She evolved to respiratory failure. Magnetic resonance imaging (MRI) of the brain and cervical spine showed extensive bilateral and symmetric restricted diffusion involving the subcortical and deep white matter, a focal hyperintense T2/ FLAIR lesion in the splenium of the corpus callosum with restricted diffusion, and extensive cervical myelopathy involving both white and gray matter. Follow-up examinations of the brain and spine were performed 30 days after the first MRI examination. The images of the brain demonstrated mild dilatation of the lateral ventricles and widespread widening of the cerebral sulci, complete resolution of the extensive white matter restricted diffusion, and complete resolution of the restricted diffusion in the lesion of the splenium of the corpus callosum, leaving behind a small gliotic focus. The follow-up examination of the spine demonstrated nearly complete resolution of the extensive signal changes in the spinal cord, leaving behind scattered signal changes in keeping with gliosis. She evolved with partial clinical and neurological improvement and was subsequently discharged.

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Factors Related to Long Term Motor, Behavioral, and Scholastic Outcome in Children with Acute Disseminated Encephalomyelitis

Cited by 11 publications

References 21 publications

Central nervous system tumefactive demyelinating lesions: Risk factors of relapse and follow-up observations

Central nervous system tumefactive demyelinating lesions: Risk factors of relapse and follow-up observations

Diagnostic Considerations in Acute Disseminated Encephalomyelitis and the Interface with MOG Antibody

Acute disseminated encephalomyelitis in a COVID-19 pediatric patient

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