Acute disseminated encephalomyelitis in childhood: Single center experience

Year 2013, Volume: 40 Issue: 4, 611 - 615, 01.12.2013

Ayşe Kartal Kürşad Aydın

https://doi.org/10.5798/diclemedj.0921.2013.04.0342

Abstract

Objective: To describe the epidemiologic, clinical, neuroimaging, and laboratory features; treatment; and outcome in a cohort of children with acute disseminated encephalomyelitis (ADEM). Methods: Clinical features, laboratory and radiological findings of 14 patients with the diagnosis of ADEM were recorded in 2004-2010 in the range of 6-year follow-up time period in Pediatric Neurology Department of Selçuk University. Results: Ten patients were boys and four were girls. Ten patients presented either in winter or in spring. The majority of patients (64.2%) had as history of acute febrile illness. Patients presented most often with gait disturbances (71.4%) and secondly with altered consciousness (57%). Despite rigorous microbiologic testing, a definite microbiologic diagnosis was established only in four patients. Brain magnetic resonance imaging (MRI) identified lesions in the cortex and, or in subcortical white matter, especially in the frontal (57%) and temporal (42%) regions. Ten patients were treated with corticosteroids, and four were treated with intravenous immunoglobulin. Ganciclovir and clarithromycin were administered in patients with Epstein-Barr virus and mycoplasma according to the serology. In 13 patients, all neurologic signs and symptoms resolved after treatment. Conclusion: The present series demonstrates that acute disseminated encephalomyelitis in children occurs predominantly in winter and spring and often follows an upper respiratory tract illness.

Keywords

Acute disseminated encaphalomyelitis, childhood, MRI

Çocukluk çağında akut dissemine ensefalomiyelit: Tek merkez deneyimi

Abstract

Amaç: Çocuklarda akut dissemine ensefalomyelitin (ADEM) epidemiyolojik, klinik, nöro-görüntüleme ve laboratuvar bulguları ile tedavi ve sonuçlarının araştırılması amaçlandı. Yöntemler: Selçuk Üniversitesi Pediatrik Nöroloji Bilim Dalında Ocak 2004-Ocak 2010 aralığındaki altı yıllık zaman diliminde ADEM tanısı ile takip edilen on dört hastanın öyküleri, klinik özellikleri, laboratuar ve radyolojik bulguları kaydedildi. Bulgular: Olgularımızın onu erkek, dördü kız idi. On hastanın başvuru mevsimi kış ya da ilkbahar ayı idi. Hastaların büyük kısmında (%64,2) geçirilmiş akut ateşli hastalık öyküsü vardı. En sık görülen başvuru semptomları yürüme bozukluğu (%71,4) ve bilinç durumunda değişiklik (%57) idi. Detaylı laboratuvar incelemelerine rağmen sadece dört hastada mikrobiyolojik ajan gösterilebildi. Kranial magnetik rezonans görüntülemede (MRG) kortikal ve subkortikal beyaz cevher tutulumu özellikle frontal (%57) ve temporal (%42) tutulum saptandı. On hasta kortikosteroid, 4 hasta ise intravenöz immunglobülin tedavisi aldı. Ebstein-Barr virüs ve mikoplazma serolojisi pozitif olan hastalara gansiklovir ve klaritromisin tedavisi verildi. Onüç hastada tedavi ile nörolojik şikayet ve bulgular tamamen kayboldu. Sonuç: Bu seride çocuklarda ADEM\'in esas olarak kış ve ilkbahar aylarında ve bir üst solunum yolu enfeksiyonunu takiben ortaya çıktığı bulundu.

Keywords

Akut dissemine ensefalomiyelit, çocukluk çağı, MRG

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