Clinical analysis and follow-up study of 32 children with first diagnosed acute disseminated encephalomyelitis / 国际儿科学杂志

ABSTRACT

Objective:To analyze the clinical features, risk factors of the prognosis and recurrence of first diagnosed acute disseminated encephalomyelitis(ADEM)in children.Methods:The clinical characteristics of 32 children with first diagnosed ADEM who were treated in the Department of Neurology of Shanghai Children′s Medical Center from January 1, 2012 to January 31, 2022 were analyzed retrospectively and followed up.Results:After follow-up, 27 of the 32 patients were diagnosed as ADEM and 4 were diagnosed as multiphasic disseminated encephalomyelitis(MDEM), 1 was diagnosed as ADEM followed by optic neuritis(ADEM-ON).Among the 27 patients diagnosed with ADEM, most of them were girls, 3~8 years old, had a history of infection before onset, occurred in summer and autumn.Common clinical symptoms included disturbance of consciousness or mental and behavior disorders(27/27, 100.0%), fever(13/27, 48.1%), paralysis(13/27, 48.1%), abnormal defecation(7/27, 25.9%), decreased vision(7/27, 25.9%)and so on.Brain MRI mainly involved subcortical white matter(20/27, 74.1%), cerebellum(10/27, 37.0%), deep nuclei such as thalamus and basal ganglia(7/27, 25.9%)and brainstem(3/27, 11.1%).In 10 cases, myelin oligodendrocyte glycoprotein(MOG)antibody tests showed positive results in 3(30.0%)and negative results in 7(70.0%).There were no significant differences in gender, age, history of infection before onset, season of onset, clinical symptoms, peripheral WBC, CRP, erythrocyte sedimentation rate, levels of WBC and protein in cerebrospinal fluid, electroencephalogram, brain and spinal cord MRI, treatment and prognosis between the MOG antibody positive and negative children(all P>0.05).16 cases (59.3%)were recovery completely, 11 cases (40.7%)were not, the rate of the infection before onset of the former was higher than the latter( P<0.05).27 cases (84.4%)had monophasic course and 5 cases (15.6%)had non-monophasic course, more of the nonmonophasic children′s brain MRI show multiple abnormal signals in the brain than the monophasic children( P<0.05). Conclusion:Children with first diagnosed ADEM require long-term clinical follow-up, and brain MRI show a higher risk of recurrence of multiple abnormal signals in the brain.The prognosis of ADEM children with a history of infection before onset is relatively good.