Acute disseminated encephalomyelitis in children and adolescents – 20-year single-center experience in Serbia

Abstract

Introduction/Objective Acute disseminated encephalomyelitis (ADEM) is the most common demyelinating disease of the central nervous system in pediatric patients. We aimed to evaluate the clinical profile of children with ADEM and to discern prognostic factors for disease outcome.

Methods A 20-year retrospective–prospective study was conducted in a cohort with the diagnosis of ADEM.

Results The study included 36 patients, with range of follow-up period of 6–120 months (median of 26 months). Prior infection was reported in 72.2% of the patients. In the clinical presentation of the disease, motor deficit was most common (81.1%), followed by ataxia (77.8%). More than a third of patients had back and limb pain or abdominal visceral pain, which highly correlated with MRI findings of myelitis. Abnormal brain CT findings were evident in 22.2% of the patients, and this was associated with higher Expanded Disability Status Scale (EDSS) and quicker progression of the disease. Median EDSS was 0 at the most recent follow-up visit, in all the patients. EDSS 0–2.5 was verified in 29 (80.6%) of the patients, while three (8.3%) patients scored 7–9.5 at the last visit. Two patients had a lethal outcome.

Conclusions ADEM is a serious disease in pediatric patients, but with a good prognosis, which is illustrated by the fact that 80.6% of our patients had a complete or almost complete recovery.

Keywords: encephalomyelitis; demyelination; children; adolescents; prognosis