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Neuropediatrics 2003; 34(4): 194-199
DOI: 10.1055/s-2003-42208
Original Article

Georg Thieme Verlag Stuttgart · New York

Acute Disseminated Encephalomyelitis in Children: Outcome and Prognosis

B. Anlar 1 , C. Basaran 2 , G. Kose 3 , A. Guven 3 , S. Haspolat 4 , A. Yakut 5 , A. Serdaroglu 6 , N. Senbil 7 , H. Tan 8 , E. Karaagaoglu 9 , K. Karli Oguz 10
  • 1Hacettepe University Department of Pediatric Neurology, Ankara, Turkey
  • 2Hacettepe University Department of Physiology, Ankara, Turkey
  • 3Social Security Hospital, Department of Pediatric Neurology, Ankara, Turkey
  • 4Akdeniz University Department of Pediatric Neurology, Antalya, Turkey
  • 5Osman Gazi University Department of Pediatric Neurology, Eskisehir, Turkey
  • 6Gazi University Department of Pediatric Neurology, Ankara, Turkey
  • 7Dr. Sami Ulus Children's Hospital, Ankara, Turkey
  • 8Ataturk University Department of Pediatric Neurology, Erzurum, Turkey
  • 9Hacettepe University Department of Biostatistics, Ankara, Turkey
  • 10Hacettepe University Department of Radiology, Ankara, Turkey
Further Information

Publication History

Received: January 20, 2003

Accepted after Revision: May 5, 2003

Publication Date:
15 September 2003 (online)

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Abstract

Background

Acute disseminated encephalomyelitis (ADEM) is the most common demyelinating disorder of childhood. Its clinical features, prognosis and treatment vary in different reports.

Objectives

To examine a series of children with ADEM for clinical findings, course, recurrences, and possible variables affecting outcome.

Methods

Multicentric data collected from 7 tertiary referral centers were registered and evaluated in a central database in 1990 - 2001 for clinical, laboratory, and MRI features. Course and prognosis were assessed in patients with at least 12 months' follow-up.

Results

Forty-six patients were evaluated. Median age at onset was 8 years, M/F ratio, 1.7/1. Most common symptoms and signs pertained to the motor system and consciousness. Of 39 children with 12 months' follow-up, 71 % recovered completely. Thirteen (33 %) children had relapses. Patients who had more than one relapse (n = 4) presented with new symptoms at each attack. Treatment with high-dose methylprednisolone was associated with complete recovery, and tapering over more than 3 weeks, with a lower rate of relapses. MRI lesions could persist even in asymptomatic patients; in particular, periventricular lesions tended to disappear later than others.

Conclusions

Complete clinical recovery is common and serious complications are rare in childhood ADEM, but the rate of relapses is considerable. Clinical picture at first relapse may help to identify patients likely to experience multiple relapses. The timing and duration of steroid treatment affects outcome.

Key words

Demyelination - childhood - acute disseminated encephalomyelitis

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M. D. Banu Anlar

Hacettepe University Department of Pediatric Neurology

Ankara 06100

Turkey

Email: banlar@hacettepe.edu.tr

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