Prognostic Factors Of Relapse Of Acute Disseminated Encephalomyelitis

Objective To analyze the risk factors of recurrence of acute disseminated encephalomyelitis(ADEM) by studying clinical manifestation, laboratory investigation,treatment, and the prognosis of patients with acute disseminated encephalomyelitis. To help clinical practitioner in treating the disease, avoiding the relapse, identifying the recurrence of the disease, and making differentiation diagnosis with optic myelitis and/or multiple sclerosis.Methods Thirty-four patients with acute disseminated encephalomyelitis treated between October 2005 and March 2014 were recruited in the study. Retrospective analysis of the clinical data including imaging of central nervous system, and the follow-up study were statistically analyzed. They were divided into two groups:monophase group(27) and multiphase group(7) according to whether they had the relapse. And risk factors of recurrence of ADEM were studied as well. As the data was categorical data so they were described by using frequency(constituent ratio) and were analyzed by using chi-square test and logistic regression analysis. Results Statistical analysis showed that there were significant differences in whether the patient presenting autonomic nervous symptoms, prolonged visual evoked potential, time gap between high-dose glucocorticoids treatment and time of onset between monophase group and multiphase group.Regression analysis showed that they may be the risk factors of recurrence of acute disseminated encephalomyelitis. The result of follow-up data showed that the difference of MRI improvement or disappear rate of lesions between the two groups was significant, delayed improment of the lesion may not have correlation with the recurrence of ADEM,but it was very important for early identification of recurrence and differenciation diagnosis of ADEM.Conclusions Autonomic nerve symptoms, prolonged visual evoked potential, time gap between high-dose glucocorticoids treatment and time of onset were risk factors of recurrence of acute disseminated encephalomyelitis. It was suggested that starting steoid treatment as soon as possible might decrease the recurrence of ADEM.Long term follow-up of the patients, especially MRI examination is very important both for early identification of recurrence and differenciation diagnosis of ADEM.