Pediatric Acute Disseminated Encephalomyelitis: Difficulties in Predicting the Outcome
Date of submission: 18-10-2017 | Date of acceptance: 30-07-2018 | Published: 29-01-2019
Introduction: Acute disseminated encephalomyelitis is a central nervous system demyelinating disease characterised by encephalopathy and multifocal neurological symptoms. This study intends to characterise a series of 15 hospitalised children diagnosed with acute disseminated encephalomyelitis and to identify the outcome prediction factors.
Methods: Retrospective observational study about a series of children hospitalised with the diagnosis of acute disseminated encephalomyelitis, admitted between 1993 and 2015, through data collected from patient medical records. Microsoft Office Excel® and R 3.1.2® software were used for the data analysis and statistical analysis, respectively. The statistical analysis included logistic regression models, log-ratio test, t-test and odds ratio with a 95% confidence interval.
Results: Most of the patients had a polysymptomatic presentation, mainly with encephalopathy, pyramidal motor signs, cranial neuropathies and ataxia. Serological and microbiological findings were positive in 53% of the children. Fourteen children were treated with glucocorticoids and four with intravenous immunoglobulin as rescue therapy. One patient developed multiphasic disseminated encephalomyelitis. All the patients recovered from the acute event, with a 100% survival rate. In the follow up period, neurologic impairment was present in 53% of the patients, and was considered moderate in more than half of them. Age at the time of diagnosis, gender, preceding symptoms, positive serologic and microbiological findings, fever at admission, length of hospital stay and altered electroencephalogram were analysed, without direct interference in the prognosis. Diagnosis and therapy institution delay did not seem to affect the clinical recovery.
Discussion: It was not possible to find factors that can predict the outcome in this case series. Although future studies with other paediatric patients with acute disseminated encephalomyelitis are necessary in order to better identify outcome prediction factors, a long-term follow-up should be performed to document recovery and confirm the diagnosis of acute disseminated encephalomyelitis.