Acute disseminated encephalomyelitis in Siriraj Hospital: Clinical manifestations and short term outcome

Abstract

Objective: To describe clinical manifestations, neuroimaging findings, and clinical outcomes in children with acute disseminated encephalomyelitis (ADEM). Material and Method: Children with a diagnosis of ADEM who were less than 15 years of age at Siriraj Hospital between January 2002 and December 2008 were retrospectively reviewed. Clinical symptoms and signs as well as cerebrospinal fluid analysis, neuroimaging findings and clinical outcomes were extracted from medical records using a standard form. Results: During the present study period, 14 children were diagnosed with ADEM. Median age was 7.2 years (range, 1.25-13 years). The most common presenting symptoms were decreased mental status (93%), weakness (71%), and fever (50%). Cranial MRI was abnormal in all patients. All but one patient received high dose intravenous methylprednisolone and a course of tapered oral prednisolone. After a mean follow-up period of 28.6 ± 19.8 months, 13 patients were classified as monophasic ADEM and one progressed to have multiple sclerosis. Eleven patients recovered completely while one was left with mild hemiparesis and the other two (one with final diagnosis of MS) with severe psycho-neurological disturbances. Conclusion: There are no specific symptoms and signs in children with ADEM. Multifocal neurological deficits along with encephalopathy and abnormal MRI findings lead to correct diagnosis. Treatment with corticosteroid may improve clinical outcomes. Some children may progress to MS. Long-term clinical and neuroimaging studies in these children are needed.