Long-Term Neurocognitive, Psychosocial, and Magnetic Resonance Imaging Outcomes in Pediatric-Onset Acute Disseminated Encephalomyelitis

Beatty, Cynthia; Bowler, R. Arthur; Farooq, Osman; Dudeck, Lindsay; Ramasamy, Deepa P.; Yeh, E. Ann; Zivadinov, Robert; Weinstock‐Guttman, Bianca; Parrish, Joy

doi:10.1016/j.pediatrneurol.2016.01.003

Cited by 33 publications

(51 citation statements)

References 31 publications

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“…Our results are consistent with those of previous studies and support findings that the outcome of pediatric ADEM was more favorable than that of pediatric multifocal CIS [3,11,22,23]. On the other hand, other recent studies showed that there are lasting neurocognitive and psychosocial deficits including ADHD and epilepsy in pediatric ADEM, and even children who were considered to have fully recovered at discharge may be affected [17,24,25]. Our study also included two patients with ADHD or epilepsy, despite them achieving full recovery in the acute phase.…”

Section: Treatments and Outcomesupporting

confidence: 92%

Clinical time course of pediatric acute disseminated encephalomyelitis

Nishiyama

Nagase

Tomioka

et al. 2019

Brain and Development

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The detailed clinical time course in acute disseminated encephalomyelitis (ADEM) from initial symptoms, through exacerbation, to remission has not been widely reported. Hence, this study aimed to investigate the clinical time course of pediatric ADEM. This was a multicenter retrospective study based on registry data from medical chart reviews. The study included children who met the international consensus diagnostic criteria for ADEM. The patients comprised 18 boys and 6 girls, with a mean age of 5.5±3.3 years at onset. From onset, the time until peak neurological symptoms, time until initial improvement, and time until full recovery was 3.1±3.7 days, 6.0±4.5 days, and 26±34 days, respectively. Twenty-three (96%) patients were treated with high-dose methylprednisolone (mPSL) with a mean duration of 4.1±4.0 days from onset. The condition of 15 patients (65%) improved within 3 days of high-dose mPSL initiation, whereas, that of four patients began to improve after >5 days of high-dose mPSL initiation. Only one patient (4%) did not achieve full recovery despite treatment with high-dose mPSL, intravenous immunoglobulin, and plasma exchange. This study presents the detailed clinical time course in pediatric ADEM in Japan. Progression of neurologic deficits typically lasts a few days, with initial improvement in 1 week leading to full recovery within 1 month. Day 140 Day 122 Day 42 Day Case Worsening period Nadir period Improving period Initiation of high-dose mPSL Initiation of IVIg 1 11 21 31

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Section: Treatments and Outcomesupporting

confidence: 92%

Clinical time course of pediatric acute disseminated encephalomyelitis

Nishiyama

Nagase

Tomioka

et al. 2019

Brain and Development

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“…None of our cases developed relapse (12) or fulfilled the criteria of multiple sclerosis as obtained by other studies (27, 28) as our follow up period was short (only 6 months) and long term follow up is needed to clarify this point. Assessment of IQ demonstrated some impairment in cognitive function, and this finding was consistent with other reports (24, 29, 30). Other data (11) showed that some of them performed at least one standard deviation below age norms in at least one cognitive domain, furthermore criteria for cognitive impairment was met in other reports (4).…”

Section: Discussionsupporting

confidence: 92%

Pattern and Outcome of Acute Disseminated Encephalomyelitis (ADEM) in Children: Experience in a Tertiary Center, Upper Egypt

Sadek¹,

Mohamed²,

Abou‐Taleb³

et al. 2016

Electron physician

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IntroductionAcute disseminated encephalomyelitis (ADEM) is an immune mediated disease of the brain. Although it occurs in all ages, most reported cases are in children and adolescents. The aims of this study were to study the clinical pattern and outcome of ADEM in children in a tertiary center in Upper Egypt and to determine the effect of combined use of steroids and IVIg on outcome.MethodsThis observational study was carried out from January 2014 through December 2014 in the Pediatric Department of Sohag University Hospital (Egypt). All children diagnosed as ADEM during a one year period were included in this study. The treatments used were IV methylprednisolone followed by oral prednisone taper and intravenous immunoglobulin for severe cases. All studied cases were followed up and reevaluated at three months and six months. We used SPSS version 10 and Chi Square, Spearman’s test and t-test for data analysis.ResultsEighteen children were included in this study (10 males and 8 females), the average age was 5.5 ± 0.9 years. Prodroma was found in 72.22% of the cases while the main complaint was encephalopathy (83.33%) followed by seizures (11.11%). The neurological findings were convulsions in 83.33%, quadriparesis (33.33%), hemiparesis (33.33), bladder involvement (both retention and incontinence) in 61.11%, and cranial nerve affection (11.11%). Demyelination patches were multifocal in 50%, mainly subcortical in 27.78%. Intelligence quotient (IQ) assessment after 6 months follow up showed that 50% were below average, 25% had mild MR while neurological evaluation showed that 75% of our patients were completely cured. The predictors of better outcome were; children related to the age group (1–4 years) (p = 0.01), children with higher GCS (6–14) (p = 0.01), and children who received steroids on the first day of symptoms and intravenous immunoglobulin in the first week (p = 0.03).ConclusionThe clinical pattern of acute disseminated encephalomyelitis is variable, and a disturbed level of consciousness was the most common presentation. The outcome is generally favorable although motor deficit and cognitive impairment were reported. The combined use of steroids and IVIg has substantial effect on the outcome in children with ADEM.

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“… 7 , 8 These problems do not limit themselves to chronic forms of demyelinating disease like MS but are also reported in children after acute disseminated encephalomyelitis (post-ADEM), although rapid motor function recovery after the acute phase in most of the patients seems to be the case. 9 – 11 …”

Section: Introductionmentioning

confidence: 99%

Fatigue and physical functioning in children with multiple sclerosis and acute disseminated encephalomyelitis

et al. 2017

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Background and Objective:Fatigue and physical impairments are a major concern in children with multiple sclerosis (MS) and after acute disseminated encephalomyelitis (post-ADEM). We here aimed to evaluate the interaction between fatigue, exercise capacity, motor performance, neurological status, and quality of life (HRQoL).Methods:In this cross-sectional study, data of 38 children (MS n = 22, post-ADEM n = 16), aged 4–17 years attending our national pediatric MS center, were studied. Fatigue was measured with the Pediatric Quality of Life Multidimensional Fatigue Scale, exercise capacity with the Bruce Protocol, motor performance with the Movement Assessment Battery for Children second edition, HRQoL with the Pediatric Quality of Life Questionnaire, and extent of disability with the Expanded Disability Status Scale (EDSS).Results:Children with MS and post-ADEM experienced more fatigue (p < 0.001), reduced exercise capacity (p < 0.001), and impaired motor performance (p < 0.001), despite low scores on the EDSS. Fatigue, but not the other parameters, was significantly correlated with HRQoL. Fatigue was not correlated with exercise capacity.Conclusion:We confirm the major impact of fatigue on quality of life in children with MS and post-ADEM. Fatigue was not explained by reduced exercise capacity or impaired motor performance. An important finding for clinical practice is that the low EDSS score did not reflect the poor physical functioning.

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Long-Term Neurocognitive, Psychosocial, and Magnetic Resonance Imaging Outcomes in Pediatric-Onset Acute Disseminated Encephalomyelitis

Cited by 33 publications

References 31 publications

Clinical time course of pediatric acute disseminated encephalomyelitis

Clinical time course of pediatric acute disseminated encephalomyelitis

Pattern and Outcome of Acute Disseminated Encephalomyelitis (ADEM) in Children: Experience in a Tertiary Center, Upper Egypt

Fatigue and physical functioning in children with multiple sclerosis and acute disseminated encephalomyelitis

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