EVALUATION OF CASES PRESENTING WITH MYELITIS IN CHILDHOOD

Yıl 2021, Cilt: 84 Sayı: 2, 245 - 248, 25.04.2021

Mahmut Aslan , Serdal Güngör

https://doi.org/10.26650/IUITFD.2019.0048

Öz

Objective: Myelitis is a monophasic inflammatory demyelinating disease of the spinal cord and brain, often of unknown origin. It is characterized with motor, sensory, and autonomic symptoms. In the childhood age group, it is most frequently seen as acute disseminated encephalomyelitis (ADEM) and transverse myelitis. In this study, the patients who presented to our clinic with myelitis were evaluated. Methods: Patients who were referred to Inonu University Paediatric Neurology Clinic with myelitis between 2012 and 2019 were included in the present study. Our patients’ diagnoses, demographic findings, treatments, and treatment responses were evaluated. Results: Thirty-eight patients, 23 with ADEM and 15 with transverse myelitis, were included in the study. The average age of patients was 8.52±4.19. Seventy-three-point nine percent (73.9%) of the ADEM patients were male, while 46.7% of the transverse myelitis patients were male. The average follow-up time with patients was 22.65±17.71 months. In terms of therapy, 28 of patients were given steroid, three were given IVIG, six were given steroid+IVIG, and one was given steroid+IVIG+plasmapheresis. Two of patients followed with transverse myelitis were polyphasic, while one was monophasic. Encephalopathy was seen in 82.6% of patients followed with ADEM, while seizure was seen in eight and fever was seen in 19. We had three anti-myelin oligodendrocyteglycoprotein (Anti-MOG) positive patients. One of these patients had optic neuritis attack after transverse myelitis and was diagnosed with neuromyelitis optic spectrum disorder. Conclusion: Myelitis is a significant neurological emergency rarely seen in childhood. The patients should be recognized and treated fast in terms of prognosis. In Anti-MOG positive patients, more care should be taken in treatment and the patients should be followed for a long period of time.

Anahtar Kelimeler

Myelitis, ADEM, transversemyelitis, anti-MOG

ÇOCUKLUK ÇAĞINDA MİYELİT İLE BAŞVURAN OLGULARIN DEĞERLENDİRİLMESİ

Öz

Amaç: Miyelit spinal kordun ve beyinin genellikle sebebi bilinmeyen monofazik inflamatuvar demiyelinizan bir hastalığıdır. Motor, duyusal ve otonomik semptomlar ile karakterizedir. Çocukluk yaş grubunda en sık akut dissemine ensefalomiyelit (ADEM) ve transvers miyelit olarak karşılaşırız. Bu çalışmada miyelit ile kliniğimize başvuran hastaları değerlendirdik. Gereç ve Yöntem: Bu çalışmaya 2012-2019 yılları arasında İnönü Üniversitesi Çocuk Nöroloji kliniğine miyelit ile başvuran hastalar alındı. Hastalarımızın tanısı, demografik bulguları, tedavi ve tedaviye yanıtları değerlendirildi. Bulgular: Çalışmaya 23’ü ADEM, 15’i transvers miyelit olmak üzere 38 hasta dahil edildi. Hastalarımızın yaş ortalaması 8,52±4,19 yıl idi. Çalışmaya alınan ADEM hastalarının %73,9’u; transvers miyelitli hastaların %46,7’si erkekti. Hastaların ortalama takip süresi 22,65±17,71 aydı. Hastalara tedavi olarak 28’ine steroid, 3’üne IVIG, 6’sına steroid+IVIG, 1’ine ise steroid+IVIG+plazmaferez tedavileri verildi. Transvers miyelit ile takipli hastanın ikisi polifazik, biri monofazikti. ADEM ile takipli hastaların %82,6’sında ensefalopati, 8’inde nöbet, 19’unda ateş izlendi. Anti-miyelin oligodendrosit glikoprotein (Anti-MOG) pozitif olan 3 hasta vardı. Bu hastaların biri tranvers smiyelit sonrası üç defa optik nörit atağı geçirdi ve nöromiyelitis optika spektrum bozukluğu tanısı aldı. Sonuç: Miyelit çocukluk çağında nadir görülen önemli bir nörolojik acildir. Prognoz açısından hastaların hızlı tanınıp tedavi edilmesi gerekmektedir. Anti-MOG pozitif hastalarda ise tedavide daha dikkatli olunmalı ve uzun dönem takip edilmelidir.

Anahtar Kelimeler

Miyelit, ADEM, transvers miyelit, anti-MOG

Kaynakça

• 1. Krupp LB, Tardieu M, Amato MP, Banwell B, Chitnis T, DaleRC, et al. International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: revisions to the2 007 definitions. MultScler 2013;19:1261–7. [CrossRef]
• 2. Nishiyama M, Nagase H, Tomioka K, Tanaka T, Yamaguchi H, Ishida et al. Clinical time course of pediatric acute disseminated encephalomiyelitis. Brain Dev 2019;41(6):531- 7. [CrossRef]
• 3. Tavasoli A, Tabrizi A. Acute Transverse Miyelitis in Children, Literature Review. Iran J Child Neurol. 2018;12(2):7-16.
• 4. Koelman DL, Chahin S, Mar SS, Venkatesan A, Hoganson GM,Yeshokumar AK, et al. Acute disseminated encephalomiyelitis in 228 patients: a retrospective, multi center US study. Neurology 2016;86:2085–93. [CrossRef]
• 5. Yamaguchi Y, Torisu H, Kira R, Ishizaki Y, Sakai Y, Sanefuji M,et al. A nation wide survey of pediatric acquired demyelinating syndromes in Japan. Neurology 2016;87:2006-15. [CrossRef]
• 6. Mikaeloff Y, Suissa S, Vallee L, Lubetzki C, Ponsot G,Confavreux C, et al. First episode of acute CNS inflammatory demyelination in childhood: prognostic factors for multiple sclerosis and disability. J Pediatr 2004;144:246-52. [CrossRef]
• 7. Absoud M, Greenberg BM, Lim M, Lotze T, Thomas T, Deiva K. Pediatric transverse miyelitis. Neurology. 2016;87(9 Suppl 2):S46-52. [CrossRef]
• 8. Kitley J, Woodhall M, Waters P, Leite MI, Devenney E, Craig J,et al. Myelin-oligodendrocyte glycoprotein antibodies in adults with a neuromiyelitis optica phenotype. Neurology 2012;79:1273-7. [CrossRef]
• 9. Torisu H, Kira R, Ishizaki Y, Sanefuji M, Yamaguchi Y, Yasumoto S, et al. Clinical study of childhood acute disseminated encephalomiyelitis, multiple sclerosis, and acute transverse miyelitis in Fukuoka Prefecture. Japan. Brain Dev 2010;32:454–62. [CrossRef]
• 10. Reindl M, Waters P. Myelin oligodendrocyte glycoprotein antibodies in neurological disease. Nat Rev Neurol. 2019;15(2):89-102. [CrossRef]