| ObjectTo analyze the clinical data of AEDM,and explores the clinical features of children with acute disseminated encephalomyelitis and the risk factors predisposing to poor prognosis,To provide a basis for improving the understanding of clinical pediatricians on ADEM and the early and accurate intervention of children with ADEM to improve the prognosis.MethodsThe clinically confirmed cases of acute disseminated encephalomyelitis were collected from January 1st,2009 to December 1st,2018 at the Pediatric Medical Center of Qilu Hospital of Shandong University,and clinical data were analyzed retrospectively.The general data,predisposing factors,initial symptoms,clinical manifestations,cerebrospinal fluid and imaging characteristics of the patients were counted.Each patient was followed up,by the Expanded Disability Status Scale of Kurtzke(EDSS),the neurological state of the children were assessed,and the EDSS score results of different gender,age,onset seasons,prodromal history,mode of onset,course of disease,clinical manifestations and imaging results were compared in detail.The data is processed by SPSS22.0 statistical software.The counting data is described by frequency or percentage.The measurement data is expressed by meanąstandard deviation or median(interquartile range representation).For single factor analysis,the count data was analyzed by chi-square test or Fisher's exact test;the measurement data that conformed to the normal distribution and the homogeneity of variance were analyzed by t test,and the measurement data that did not conform to the normal distribution were tested by rank sum test,P<0.05 was statistically significant.significance.Binary logistic regression model was used to analyze the independent risk factors affecting the poor prognosis of children,with a=0.05 as the test level.Results1.General information:This study included 67 cases of acute disseminated encephalomyelitis,the most common in children aged 3-10 years,accounting for 61.2%of the total;42 cases(62.7%)of male children,male to female ratio 1.68:1.There were onset in all seasons,with the most cases occurring in spring,with 21 cases(31.3%).2.Initial symptoms:non-specific symptoms were predominant,with a total of 45 cases(67.2%),including 33 cases of fever(49.3%),15 cases of dizziness and headache(22.4%),and 10 cases of nausea and vomiting(14.9%).Other symptoms included 15 cases of epileptic seizures(22.4%),12 cases of disturbance of consciousness(17.9%),25 cases of paralysis(37.3%),7 cases of ataxia(10.4%),3 cases of sphincter dysfunction,4 cases of visual impairment,3 cases of paresthesia,2 cases of abnormal mental behavior,1 case each of speech impairment and cranial nerve damage.3.Clinical manifestations:45 cases(67.2%)had no obvious inducement,13 cases(19.4%)had a history of respiratory tract infection 1 month before the onset,1 case had a history of chickenpox,and 1 case had a history of diarrhea.6 patients had a history of vaccination before the disease(9.0%).Two patients had a history of viral encephalitis 1-2 months before the disease.Most of the cases were acute or subacute,with 50 cases of acute onset(74.6%).Subacute onset in 10 cases(14.9%);There were only 7 cases of chronic onset(10.5).The clinical manifestations of ADEM children were diverse,including:encephalopathy in 44 cases(65.7%);Fever in 44 cases(65.7%);There were 23 cases of consciousness disturbance(34.3%),11 cases of ataxia(16,4%),32 cases of limb paralysis(47.8%),including 15 cases of quadriplegia(22.4%)and 11 cases of paraplegia(16.4%),most of which were quadriplegia.Sphincter dysfunction was found in 20 cases(29.9%)and seizure in 18 cases(26.9%).Abnormal mental behavior in 9 cases(13.4%);Paresthesia in 12 cases(17.9%);Cranial nerve involvement in 11 cases(16.4%);23 cases(34.3%)had nausea and vomiting.Dizziness and headache in 21 cases(31.3%);Eight cases(11.9%)had blurred vision or blindness.Double vision in 2 cases;Facial paralysis in 3 cases;Speech impairment in 4 cases(6.0%);Nystagmus in 3 cases;One case of double eyelid droop.40 cases(59.7%)had pyramidal tract sign.4.Blood examination:blood analysis was performed on 67 cases of children after admission,including 13 cases(19.4%)with white blood cell count of>12.0×109/L and 4 cases with white blood cell count<4.0 × 109/L.The minimum value of HGB was 72g/L in 14 patients(20.9%)with anemia.52 patients(77.6%)had platelets greater than 300 ×109/L.Blood sedimentation rate>15mm/h in 51 eases(76.1%),the highest value was 120mm/h.C reactive protein>8mg/L in 2 cases.Antibodies against mycoplasma pneumoniae were detected in 56 children,among which 14(25.0%)were antibody positive(with a ratio greater than 1:80).5.Cerebrospinal fluid examination:lumbar puncture examination was performed in 59 children,and the number of cerebrospinal fluid cells was 10>/mm333(55.9%),with the highest value of 449/mm3,mainly mononuclear cells were elevated.Cerebrospinal fluid protein(CSF)was elevated in 11 cases(18.6%),up to 1.55g/L.Among the 42 patients who underwent cerebrospinal fluid immunoglobulin examination,21(50%)were abnormal,among which 15(35.7%)had increased IgG,13(3 1.0%)had increased IgM,and 5(11.9%)had increased IgA.Cerebrospinal fluid oligoclonal band was performed in 39 patients,Six cases(15.4%)were positive.Anti-MOG antibody was detected in 10 children,and positive in 5(50%).14 cases were examined with MBP antibody,only one(7.1%)was found to be positive.6.MRI examination of craniocerebral and spinal cord:all 67 children received MRI examination of craniocerebral,among which 60(89.6%)were abnormal,all showed multiple long T1 long T2 signals or constant T1 long T2 signal with asymmetric distribution in the brain,and T2FLAIR showed hyperintensity.MRI examination of the spinal cord was performed in 53 children,and abnormalities were found in 32(60.38%).7.Outcome at discharge:hospital stay ranged from 8 days to 31 days,with an average of 19.51 days.The symptoms and signs disappeared completely in 41cases(61.2%).Ten patients(14.9%)had mild clinical symptoms or only abnormal physical signs on physical examination.Sixteen patients(23.9%)were discharged with facial paralysis,limb movement disorder,paresthesia,decreased vision and urinary retention.8.Risk factors:according to EDSS score,51 patients in the good prognosis group(76.1%)and 16 patients in the bad prognosis group(23.9%).Univariate analysis showed that coma,epileptic seizure,abnormal muscle strength,dystonia,tetraplegia,spinal cord involvement,weakened tendon reflex,weakened abdominal wall reflex,and EDSS score were associated with adverse outcomes at discharge(P<0.05).Binary Logistic regression multivariate analysis showed that coma and seizures were independent risk factors for poor prognosis of acute disseminated encephalomyelitis(P<0.05).ConclusionsADEM is more common in children and adolescents,and the ratio of male to female is equal roughly.The four seasons all may come on,and the spring comes on most;Most of the patients presented acute or subacute onset,and the clinical manifestations were lack of specificity,mainly manifested as encephalopathy and multifocal neurological dysfunction.ADEM has a good prognosis in general,and some children may have facial paralysis,limb movement disorder,decreased vision,urinary retention and other symptoms when discharged from hospital.It is suggested that coma and epileptic seizure are the risk factors for poor prognosis of ADEM,and active intervention should be given to the children who predict poor prognosis to improve the prognosis. |
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