Clinical Features Of Children With Acute Disseminated Encephalomyelitis And Related Recurrence Factors

Objective: To study the clinical features of children with acute disseminated encephalomyelitis and related recurrence factors.Methods: The clinical data of 73 children first diagnosed as ADEM who were hospitalized from November 2011 to January 2017 were collected,and followed up by telephone or returned to the hospital.The clinical characteristics,auxiliary examinations and treatment were analyzed retrospectively to evaluate the related recurrence factors of ADEM.Results: 1.A total of 73 children with ADEM were included,including 35 boys(48%)and 38 girls(52%),aged from 1 to 16 years and 11 months,with an average age of 7±3 years,and the most common age of onset was 4 to 7 years old(51%,37).2.Among the 73 children,43(59%)had precipitating factors,41(56%)had a history of infection before onset and 7(10%)had a history of vaccination.The first symptom of each child were different,and the non-specific symptoms(such as fever/headache/ vomiting)were more common(58%,42).3.All children had the symptoms of encephalopathy,including disturbance of consciousness in 47 children(64%)and mental and behavioral disorders in 54 children(74%).Pyrexia was observed in 53 children(73%),dyskinesia in 47 children(64%),headache in 47 children(64%)and vomiting in 40 children(55%).4.Brain MRI was performed for 65 children and the results showed involvement of the subcortical white matter(83%,54/65),the deep nuclei(60%,39/65),the brain stem(58%,38/65)and the cerebellum(42%,27/65).Spinal cord involvement was observed in 20 children(20/43,47%).5.after the first onset of the disease,43 patients(59%)were treated with glucocorticoid and IVIG,22 patients(30%)were given IVIG alone,5 patients(7%)were given glucocorticoid alone,and 3 patients(4%)were not treated with IVIG or glucocorticoid.6.Among the 73 children,only 1 child died,2 children left nerologic sequelae,15 children had relapsed,and 55 children reached the state of complete remission at the end of the follow-up.15 relapsed patients were diagnosed as ADEM 4 case,MS 7 case,NMOSD 2 case,and 2 case could not be classified.7.Compared with the non-recurrence group,the recurrence group had signifcantly higher percentages of children with deep nucleus involvement(P=0.043),with injury in ?3 spinal segments(P=0.005)and with a time from disease onset to gamma-globulin/hormone treatment of >2 weeks(P=0.033).Conclusion: 1.There is no gender difference in the incidence of children with ADEM,and the peak age is 4 to 7 years old.There is often a history of infection or vaccination before onset,but which is not a specific indicator for the diagnosis of ADEM.2.the non-specific symptoms(such as fever/headache/ vomiting)are the most symptom at onset,ADEM in children have various clinical manifestations,and lack of specificity in laboratory examination.However,brain MRI is of great significance in the diagnosis,differential diagnosis,prognosis evaluation and recurrence of this disease.3.Efficacy of glucocorticoid and IVIG therapy for ADEM patients,Only a small number of children may relapse,and finally diagnosed as ADEM?MS or NMOSD.4.Deep nucleus involvement on MRI,long spinal segmental injury(?3 segments)and late treatment with IVIG/hormone(>2 weeks)may be associated with the recurrence of ADEM.