Acute disseminated encephalomyelitis in children and adolescents: a single center experience

Abstract

Background: Acute disseminated encephalomyelitis is an immune-mediated disease that produces multiple inflammatory lesions in the brain and spinal cord.

Methods: This study retrospectively evaluated 15 children with acute disseminated encephalomyelitis in children and adolescents from a single institution in Adana, Turkey.

Results: The patients presented in a seasonal distribution, with 73.3%: (11/15) presenting in winter or spring. The majority of patients (13/15, 86.7%) had a history of acute febrile illness 2 to 40 days before presentation, and five children had serologic evidence of specific triggers: mycoplasma (2 children), influenza-A (H1N1) (1 child), or Epstein-Barr virus. All children were treated with a standard protocol of 3 to 5 days of intravenous administration of methylprednisolone and intravenous immunoglobulin for patients who continued to deteriorate. Oseltamivir and clarithromycin were administered in patients with influenza-A (H1N1) and mycoplasma according to the serology. In 13 patients, all neurologic signs and symptoms resolved after treatment. Only one patient was left with severe neurologic sequelae and another child had recurrent attacks and was ultimately diagnosed with possible multiple sclerosis.

Conclusions: The present series demonstrates that acute disseminated encephalomyelitis in children occurs predominantly in winter or spring and often follows an upper respiratory tract illness for those along the southern coast of Anatolia (Mediterranean region). Early treatment with immunomodulative agents is recommended and is likely to result in a favorable outcome or full recovery. This study also suggests benefit from antiviral and antibiotic treatment initiated as soon as possible after the onset of illness.

Keywords: Alzheimer's disease; Turkey; acute disseminated encephalomyelitis; adolescents; children; multiple sclerosis.

Figure 1

(A) Computed tomography shows hypodensity in the left periventricular white matter (arrows), and (B) fluid-attenuated inversion recovery MRI sequence shows multiple hyperintense lesions in the periventricular white matter and left thalamic. (C) Follow-up brain MRI obtained 1 month later shows size decrease and no appearance of new lesions (arrows).

Figure 2

(A) The first MRI scan shows multiple hyperintense lesions in the subcortical and deep white matter. (B) One year later, a follow-up MRI shows partial resolution of the lesions. (C) One month after the scan shown in part B, brain MRI shows new lesions in the right frontoparietal subcortical and deep white matter. (D) Follow-up brain MRI image obtained 6 months later shows partial resolution of the these lesions and new lesion in the left parietal subcortical white matter.